ObamaCare, the Comic Book

The case for the health care law is just as annoying in cartoon form.


Health care is a giant fat person crushing Congress. Or at least that's the picture readers get—quite literally—from reading Jonathan Gruber's Health Care Reform: What It Is, Why It's Necessary, How It Works, a desperate attempt to make the case for Obama­Care in graphic novel form. 

Gruber, an economist at the Massachusetts Institute of Technology, served as a chief architect of Mitt Romney's Massachusetts health care reform, which provided the model for the 2010 Patient Protection and Affordable Care Act (PPACA). He then worked as a paid consultant for the widely unpopular federal law. Gruber plays a central role in his own book, appearing as a nerdy-looking cartoon character who guides readers through an illustrated version of federal health policy basics with exciting lines like "the best and most comprehensive parts of the ACA are yet to come." 

Why deploy cartoon Gruber to battle cartoon villains such as a mummy who warns that Obama­Care won't cover the uninsured and a lagoon creature who tries to scare people into thinking the law will cause insurance premiums to rise? Perhaps because at this point the law's defenders are desperate enough to try anything to make it more popular. This is a far cry from the run-up to PPACA's passage, when Democratic strategists convinced themselves that sagging public support would be turned around once people finally understood the law's benefits.

Since then, ObamaCare supporters have engaged in superpowered efforts to explain just how great it is, launching a series of expensive advertising campaigns and advocacy groups. None has worked yet. In the nearly two years since the law passed, PPACA's poll numbers have gotten worse, not better. Pollster.com's multipoll trend aggregate showed in January that 50 percent of the public opposes the law, while just 37 percent approves, the latter down from 43 percent in May 2010. It may be that voters have learned as much as they need to know about ObamaCare and have adjusted their opinions accordingly. 

In any case, Gruber's comic book argument isn't likely to stanch the bleeding. Those who follow the intricacies of health policy and politics will learn nothing new, and those who don't will find themselves facing little more than a dull, blandly illustrated version of the same talking points that apologists have been using for years.

At times Gruber's book reads less like a comic and more like a White House press release. Cartoon Gruber happily assures readers that ObamaCare "is not socialism" but instead "a unique piece of legislation that delivers benefits to citizens while actually lowering the deficit." ObamaCare "makes sure the sick have someplace to turn for their insurance coverage" and keeps insurance companies in line by "subject[ing] them to regulations on their 'medical loss ratios.'?"

As in the noncartoon world, those talking points tell only a highly selective part of the story. When discussing the decades-long rise in health care costs, for example, Gruber notes the existence of the two largest health entitlements, Medicare and Medicaid, but tiptoes around their substantial role in driving up health spending. He argues that the private sector has no incentive to cut its own costs because that would deprive the medical industry of income—but ignores the role that untamed entitlement spending and easy-money government payment schemes have had in squelching the kind of price-based competition that restrains costs in other markets. He says that the "evidence-based" assessments of the law provided by the Congressional Budget Office (CBO) demolish conservative arguments against it but does not mention that the CBO's alternative budget outlook predicts that many of the law's cost-control schemes won't last. The result is a dull mix of policy speak, oversimplification, and partisan parsing.

Gruber combines telltale omissions with dubious logic. Responding to the argument that government doesn't have any reason to be involved in providing or paying for health coverage, he explains that thanks to Medicare and Medicaid, "state and federal governments already pay for about half of the cost of all medical care." He notes that government health spending has grown from a relatively modest percentage of the budget in 1960 to the single largest budget expense today—and will continue to grow until it overwhelms the federal budget. This is where the illustration of the fat person crushing Congress comes in. 

But since the two health care entitlements were established in 1965, doesn't this suggest that they are the source of the cost problem? If previous health care entitlements are wrecking the federal budget, why is adding another one the solution? Gruber's argument seems to be that the government needs to be involved in health care because the government is already involved in health care.

Most pages of Health Care Reform resemble a children's coloring book more than a graphic novel. Nathan Schrieber's simple black-and-white art adds little to the argument. When cartoon Gruber identifies what he believes are the twin problems of American health care—rising costs and a growing number of uninsured—they are represented by a grinning, two-headed alligator that does nothing to make Gruber's point. 

The book takes the form of a long lecture, words and images swimming in the cluttered visual metaphors of Gruber's mind. But it offers nothing like the enveloping dream logic of great surrealist comic memoirs such as Craig Thompson's Blankets or the clarity and informational elegance of historical explainers such as Apostolos Doxiadis and Christos Papadimitriou's Logicomix

One might think that the point of presenting an argument for ObamaCare in comic book form is to deliver complex ideas in a simple way. Instead, Gruber has chosen to present simple ideas in a simple way, favoring easy talking points over a substantive grappling with the distortions that decades of subsidies, tax breaks, regulations, and entitlement programs have inflicted on the cost and delivery of health care in the United States.

In the process, Gruber gets the story backward and identifies the wrong villain. Health care isn't a giant fat person crushing Congress. If anything, it's the other way around: Congress, through laws like ObamaCare, is crushing American health care.

Peter Suderman is a senior editor at reason.