“A Promised Land” by Barack Obama (4)

There is a famous quote, usually – but wrongly – attributed to the German politician Otto von Bismarck, which was in fact written by the American poet John Godfrey Saxe: “Laws, like sausages, cease to inspire respect in proportion as we know how they are made”.

This observation was in my mind as I read the 50 pages which Obama devotes to explaining the tortuous process which finally led to the enactment of his signature legislative achievement: the Affordable Care Act (ACA) often called Obamacare.

To most non-Americans, the case for reform would look compelling: in spite of the US spending a lot more money per person on healthcare than any other advanced economy, the results were similar or worse and, in spite of Medicare for seniors and Medicaid for the poor, more than 43 million Americans were uninsured.

Even Obama thought the argument was powerful: “When I think back to those early conversations, it’s hard to deny my overconfidence. I was convinced that the logic of healthcare reform was so obvious that even in the face of well-organized opposition I could rally the American people’s support”.

But the legislative process in the US is much more complicated than in other democratic nations, mainly because of the constitutional dispersal of power, the financial clout of lobbyists and campaign funders, and the bitterest political divide in the nation since the civil war.

So the process took over a year and the Bill of 906 pages was only passed with a final vote margin of seven. Even then, a substantial series of compromises was forced on Obama, such as abandonment of ‘the public option’.

But, in spite of four years of Trump’s efforts to destroy Obamacare, it survives and President Biden now has a foundation on which he can build.


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