Unpacking Obamacare: how the president's signature law came into effect, and what might come next.

• Author: Suderman, Peter
• Position: Culture and Reviews - America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System; Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care - Book review

America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, by Steven Brill, Random House, 528 pages, $28

Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care, by Philip Klein, Washington Examiner, 112 pages, $9.99

Near the beginning of America's Bitter Pill, journalist Steven Brill describes an episode in which he was whisked through a hospital on the way to a major heart surgery. His book, he then promises, will be a "roller-coaster story of how Obamacare happened, what it means, what it will fix, what it won't fix, and what it means to people like me on that gurney consuming the most personal, most fear-inducing products--the ones meant to keep us alive."

This is an exaggeration; the narrative is less of a rapid roller-coaster thrill ride and more of a long journey on a rickety wagon. But it is accurate in the sense that Brill's book is largely focused on the "what" of Obamacare. Although he frames his text as a chronological narrative, and though it contains scattered moments of tension and drama, it is chiefly concerned with collecting and arranging for easy consumption the mind-numbing litany of details that informed the law's creation. Brill is always perfectly clear and at times even evocative in his scene setting, but his book is best understood as a compendium of Obamacare minutiae.

The sheer volume of detail in America's Bitter Pill can make for exhausting reading. But the journalistic record it provides is invaluable. Brill's book is a thoroughly reported look back at the law's history, from the drawn-out negotiations before its passage to the fumbled rollout of the health insurance exchanges in 2013. Brill interviewed almost all the major players in the story, and he obtained mountains of memos and internal documents, including private notes kept on high-level administration meetings and diary entries by at least one White House staffer. It is the most comprehensive single account of Obamacare's creation yet, and it effectively serves as an extended Obamacare origin story.

Many of the details Brill provides will be familiar to those who have followed the law's saga. But even the savviest Obamacare watcher is likely to find a few new nuggets, and a clearer explanation of a familiar issue. The problem comes when Brill changes roles from journalist to pundit and tries to propose an alternative approach to health care. The reader interested in different reform ideas would be better off perusing another new book, Philip Klein's Overcoming Obamacare.

Dirty Deals

Brill is particularly adept at describing the process by which the law's backers cut deals with major health industries. These agreements grew partly from a desire to avoid vocal industry opposition, which many believed had killed Bill Clinton's health care reform plan in the 1990s. On the government side, the negotiations also stemmed from a sense that the industry should shoulder much of the financial burden associated with the law; health care companies, meanwhile, were motivated to minimize damage and perhaps create an even more profitable new system.

The industry strategy was led by Billy Tauzin, the former congressman who headed the drug-industry lobbying group Pharmaceutical Research and Manufacturers of America, better known as PhRMA. The model for Tauzin's approach was the Medicare prescription drug benefit that had passed under the Bush administration, providing a boon for drug makers. If PhRMA resisted instead of...