Chapter 1 of Pre-Existing Conditions  is free to download through Nov. 24, 2025 and asks the question: Why are American health care costs high, rising, and increasingly variable across the states? The answer is lobbying. The history starts over a century ago when Congress first considered a plan for nationalized health insurance, but lobbying by the American Medical Association convinced them not to act. This kicks off a tradition of the health care industry discouraging, defeating, and diminishing "cost containment" legislation aimed at reducing the revenue of the industry.