The David Frum Show Architect of Obamacare: Health Care Is Still a Mess
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Dec 3, 2025 
Jonathan Gruber, an economist and healthcare policy expert from MIT, shares insights on the tumultuous history of the Affordable Care Act. He discusses the persistent issues plaguing the American healthcare system, including high costs and misinformation around health outcomes. Gruber contrasts the U.S. system with successful models from other countries and highlights the impact of middlemen on pricing. The duo also delves into the alarming rise of anti-vaccine sentiment and the challenges faced by public health advocacy.
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Politics Shapes Trust In Science
- The Trump administration's scandals and anti-science stances complicate health policy and research funding.
- Frum and Gruber link political misinformation to threats against vaccines and basic germ theory acceptance.
Apply Skin-In-The-Game Selectively
- Use consumer cost-sharing selectively to reduce low-value care where cheaper alternatives exist.
- Gruber recommends skin in the game for choices like nonessential surgeries and provider selection.
Shopping Won't Cure Cost Chaos
- Consumer price-sensitivity helps reduce some low-value care, but it's not the main spending driver.
- Gruber shows shopping can't solve cost variation because prices are opaque and inconsistent across providers.
