Big Medicine had done its best to keep it that way. Since 1999, it had spent nearly $6 billion on lobbying — three times what the next-largest industry, insurance, had spent. An obedient Congress had allowed Big Med to build a system in which millions couldn’t afford coverage, huge swaths of the country were essentially served by monopolies, and prices continued to go up.
“In the decade up to 2009, 79 percent of all the growth in household income was absorbed by health care,” says Dr. Brian Klepper, CEO of the National Business Coalition on Health. “Everything in Washington is rigged, but the thing most rigged is health care, because they have even more money than the banks.”
But that spring, with an enraged electorate and the economy in tatters, Obama was given a once-in-a-lifetime chance to break Big Med’s stranglehold. He vowed to do it the old-fashioned way: by introducing competition, forcing Big Med to earn its keep.
Everyone would sit “around a big table,” Obama had told a crowd in Virginia the year before. “We’ll have doctors and nurses and hospital administrators, insurance companies, drug companies. They’ll get a seat at the table. They just won’t be able to buy every chair.”