What comes after ObamaCare?

In advance of Obamacare’s launch, my expectation was that The Fixers had the best shot at taking the presidency in 2016, from the right or from the left. While Obamacare would still be anathema to the Republican base, and no candidate in his right mind (except perhaps the next Jon Huntsman) would talk of fixing it while running for the GOP nomination, if the policy worked at least well enough to not be a disaster, it would remain in force for the foreseeable future. The post-Obama conversation on the right or left would shift to the components of the measure, and long-delayed negotiations over gradualist fixes and tweaks could finally begin.

This expectation has proven, to this point, completely wrong. The likelihood of exemption and extension – of the mandate and open enrollment – on a major scale rises every week. If Obamacare effectively ends up turning into an expansion of Medicaid for about half the states, it will be far easier to repeal, and the political debate about health policy will shift dramatically away from such approaches.

Should Obamacare’s tech surge fail and lead to these types of delays, 2016 could very well turn into a three way debate: between those who think Obamacare can be fixed; those who think the problem with Obamacare was that it went too far; and those who think the problem with Obamacare was that it didn’t go far enough. In a sense, such a debate would make for a more honest depiction of the factions within health care policy and a more clear-eyed view of the unacceptable status quo. At the moment in the United States, we have the worst of both worlds: a partially single payer and partially third party payer system which does a lot of things well, but does everything for far too much, since nobody cares what something costs so long as someone else is paying for it.

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