Obama’s tepid palliation for America’s health scourges

The Obama Years: Tepid Palliation for America’s Health Scourges

By Steffie Woolhandler, MD, MPH and David U. Himmelstein, MD
American Journal of Public Health (AJPH), January 2017

President Obama inherited an economy in crisis, burgeoning inequality in wealth and health, and a legion of medically uninsured Americans whose ranks had grown by 11 million under the previous administration. He staunched the bleeding but provided no cures.

The Affordable Care Act (ACA; Pub L No. 111–148), Obama’s signature achievement, covered millions, but leaves 9% uncovered. It minimally regulated insurers and imposed a modest new tax on the wealthy but accelerated the corporate takeover of health care and endorsed high-deductible insurance plans that offer illusory protection. It provided $11 billion in new funds for community health centers and public health agencies but drained money from safety-net hospitals and failed to reverse the downward trend in funding for public health.


Could Obama have done better? Not by waging policy battles largely inside the Washington, DC, Beltway. Even during Obama’s first two years in office, when the Democrats controlled Congress, the lobbying clout of insurers and pharma (generous donors to Democrats as well as Republicans) made fundamental reform unwinnable in an inside game. The compromised ACA legislation, crafted to appease these corporate interests, offered nothing to the majority of Americans dissatisfied with the health care status quo, precluding grass roots mobilization and allowing Republicans to rally opposition. It is striking that, in a 2016 Gallup poll, 51% of Americans wanted to repeal the ACA, but 58% (including 41% of Republicans) would replace it with single-payer reform (findings that accord with a recent Kaiser survey).

The Sanders and Trump campaigns (and, indeed, Obama’s historic 2008 victory) demonstrated the electorate’s hunger for new directions. America has taken bold and difficult steps in the past: the abolition of slavery, women’s suffrage, Social Security, civil rights, and marriage equality, to name a few. All were gained through powerful, persistent social movements that eventually got their message through to Washington.

Our health and health care deficits are man-made scourges, not products of nature. Curing them will require broad popular mobilizations, not just a well-intentioned president.



By Don McCanne, M.D.

Although this AJPH editorial was written a couple of weeks before the surprise results of the presidential election were known, it does not change the message. Curing our heath care deficits will require broad popular mobilization, not just the wishes of a president, no matter his or her intentions.