After years of political infighting in Congress, President Barack Obama clearly decided his memos about health care reform weren’t going through, so he took his legacy to the next level. He just published an analysis of his health care policy in one of the premier medical journals in the world. And Obama gets away with calling out Congress and using the first person in a scientific paper, making it the only analysis of health care policy that is actually enjoyable to read.
He appears to have written this paper, published Tuesday in the Journal of the American Medicine Association, as a way to set the facts straight about the effect of health care reform, and he has the data and professional analysis to prove it. With the help of some White House-employed scientists and editors, Obama has become the first sitting president to publish a scientific paper. In doing so, he is also taking control of the narrative of the legacy of health care reform — and throwing shade at Congressional obstruction, all in the name of science.
The brunt of the paper examines the impact of health care reform on the insurance rates and prices across the country. Using government health care data from 1963 to 2015, supplemented with publically available insurance data, Obama was able to identify the impact of the Affordable Care Act. Only nine percent of the country is now uninsured, as 20 million people have been able to purchase health insurance for the first time since the passage of the bill.
Even states that have not passed the Medicare expansion provisions have seen an increase in the number of people with health insurance. Quality of hospital care has increased, as measured by the number of hospital-acquired conditions and Medicare 30-day readmission rates. Also, individuals who previously had health insurance generally have better coverage, defined as plans minus things like caps on lifetime coverage, annual caps, or a lack of catastrophe coverage.
All of that data bears the hallmark of Obama’s contributors, Matthew Fiedler and Jeanne Lambrew, an economist and a public policy scientist employed by the White House, who are acknowledged as contributors in the writing, planning, and data analysis of the study. But while they may have provided Obama with the data, his personal flourishes are all over the writing of the rest of paper (underlining is ours), including this stone-cold line: “Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported.”
After analyzing the insurance data, Obama makes four suggestions for improvements to the system.
- He says future administrations will need to recalibrate the market as it ages in order for expected premiums to continue to make sense.
- That current financial assistance plans need to be better marketed and expanded.
- He also suggests adding a public plan into areas where there are very few insurance competitors.
- Congress needs to better curtail the pharmaceutical industry.
He does make some pointed remarks at the Congressional obstruction of some of these ideas, which he attempted to implements himself and are now reliant on future presidents.
The other interesting thing about this scientific paper is that Obama uses it to evaluate his own legacy – historians take note. In the lessons he has pulled from health care legislation, he brings up the difficulty of change — particularly in the face of “hyper-partisanship,” that special interest parties like the pharmaceutical industry pose an obstacle to change, and that national policy works best when it is created through compromise.
Obama then cites individuals like John Kasich, who opposed the bill but have come around to appreciate the impact of health care reform for the people who needed it most. And then he ends with a very on-brand inspirational moment, writing, “I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere. As this progress with health care reform in the United States demonstrates, faith in responsibility, belief in opportunity, and ability to unite around common values are what makes this nation great.”