Obama, the Academic (Again)

Embracing his scholarly roots, President Obama became the first sitting president to publish an article in the Journal of the American Medical Association.

July 13, 2016
President Barack Obama

President Obama published an article in the Journal of the American Medical Association on Monday -- seemingly a first for a sitting president.

The article, titled “United States Health Care Reform: Progress to Date and Next Steps,” examines the Patient Protection and Affordable Care Act. It also offers policy makers proposals for improving the U.S. health care system.

Obama presents evidence that the law has expanded health insurance coverage to 20 million Americans. He also suggests sustaining the ACA’s provisions, improving competition in the marketplaces and cracking down on prescription drug prices.

Obama is no stranger to demanding academics: he earned a bachelor’s degree from Columbia University and a J.D. from Harvard Law School in 1991. He also spent 12 years teaching at the University of Chicago Law School.

He also has some experience with publication in scholarly journals. As a senator in 2008, he published an article in JAMA titled “Affordable Health Care for All Americans: The Obama-Biden Plan.” That same year, he also teamed up with Hillary Clinton to publish an article on malpractice in the New England Journal of Medicine.

Still, it’s unusual for an author in a medical journal to hold a J.D., rather than an M.D. It’s even more unusual for the author to be a major political figure.

The article was published as a "special communication" and was not formally peer reviewed. Many academics consider peer review the gold standard for vetting manuscripts, although some have raised concerns about the potential bias or lack of training of reviewers.

But Howard Bauchner, editor in chief of JAMA, said senior editors conducted a thorough review of the article and critiqued it. "The president was held to the same editorial standards that we would hold any author to," he said.

JAMA publishes six to eight special communications a year, Bauchner said. While articles tend to present original research or explore a clinical issue, special communications often summarize important issues, he said.

The journal published four editorials responding to Obama’s article. When selecting the authors of these editorials, "we wanted to be sure to reflect what we thought would be the spectrum of opinion about the Affordable Care Act," Bauchner said.

Peter Orszag, Obama’s first director of the Office of Management and Budget and one of the architects of the ACA, offered support for the law's accomplishments. "Fundamentally, the ACA is working," he wrote.

But the authors of the other editorials were more critical. Stuart Butler, a researcher at the Brookings Institution, argued that the president overstated the value of the ACA’s coverage gains.

Jonathan Skinner, professor of economics at Dartmouth College, and Amitabh Chandra, director of health policy research and professor of social policy at Harvard University's Kennedy School of Government, lent approval to Obama’s claim that the ACA expanded health insurance coverage to 20 million people. But they contested an assertion that the law is containing health care spending. While growth in health care spending slowed from 2010 to 2014, the slowdown actually began in 2006, before the law took effect, they wrote.

“Our major concern is about rising health care costs, and that the ACA was not directly designed to implement serious price controls,” Skinner said. “Making real cuts in spending and saying no -- either to drug companies or hospitals or providers -- is not easy. As a consequence, I haven’t yet seen huge successes in scaling back spending as a result of the ACA. That problem was not stressed in his original article.”

But Skinner said he views the article over all as a serious piece of scholarship. “This is a legitimate article,” he said. “It was well researched and careful. My guess is that JAMA would not have published something that was completely a stump speech.”

The article created a buzz on Twitter Monday evening, with some users toying with the alliterative phrase “Obama JAMA.” A few professors also poked fun at the president for returning to his scholarly roots.

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