I think President Obama won a great victory with health care reform. Clinton attempted almost 20 years earlier and ended up with nothing. Other earlier Presidents have been equally unsuccessful. Seemingly the US hodgepodge of health system was due for an upgrade. This might have rationalized our system that is a mix of a government run system (the VA), single-payer (medicare), private insurance for many and nothing but the emergency room for the rest.
It was a flawed victory though. The reform passed was perhaps ambitious beyond our means. While it reduced the deficit by imposing more taxes than the OMB judged it would create in new expenses, in so doing it has used revenue capacity to address the deficit.
The Republicans unwillingness to contribute to reform, or the President’s inability to induce them to, now puts the whole structure at risk of repeal.
I hope that the repeal and replace actually results in improvements but retains reform. But I wonder if we could end up with nothing.
This concern is shared by the incidental Economist here.
What I worry most about is the same thing that most concerns Harold Pollack:
[O]ne thing is certain. The new [health reform] law will need repairs and fixes along the way. There will be glitches. Specific legislative and regulatory provisions will require adjustment once they are tested. […]
[But,] there is just too little political space to implement midcourse corrections or enact programmatic improvements. That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote. That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.
Each side had plausible strategic and ideological reasons to pay that price. For now, anyway, our politics give us the choice between health reform that is less flexible and less carefully crafted than it really needs to be, and no reform at all. If this is the political choice presented to us, I strongly prefer the first option. I still wish we had a better way.
Health (and other types of) reform are technically hard. But, more and more, I see political obstacles as the real barriers.
Pollack’s piece, a KHN column, is worth a full read. The vast majority of it is about the CLASS provisions. I think he summarized the issues fairly. It’s about as good a brief overview as you’re likely to find.