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Based on extensive inside sources, a revealing account of how the Obama, Trump, and Biden administrations transformed both health care and politics in America

For nearly a century, every Democratic president-and many Republicans-entered office promising to restructure America's health care system. Barack Obama finally broke through but, in the process, opened a tumultuous decade in which battles over health care dominated American politics. David Blumenthal and James A. Morone go behind the scenes to describe how three very different presidents-pursuing very different goals-maneuvered through the fraught politics of health care.

President Obama ended the century-long quest for reform but ignited a screaming culture war that blazed into the Trump administration and blew up during the COVID epidemic. President Trump, facing the greatest health crisis in a century, denied and dithered. Then he directed a medical triumph in Operation Warp Speed. He and President Biden, facing the pandemic's devastation, mounted the most successful anti-poverty program in eighty years. But in the tumult, Trump launched a shattering new political war, not over coverage but over science itself.

Authoritative and gripping, this book describes the remarkable achievements of these years while also showing how respect for science clashed with scorn toward the deep state and left the nation unprepared for the next health crisis.