In honor of today’s presidential inauguration, I started making a list of exciting past, present, and future health policies advocated by the Obama administration. Thirty minutes later there was still just one word on my computer screen: OBAMACARE. Then, I came to terms with what the next four years represent for health policy: an empty page in healthcare history, colored only by the shadow of the Obamacare fight. In short: we’ve spent all of our health policy political capital, and the next few years are all about paying off the bill.
I could perhaps accept this bleak vision of the future if I thought that the Affordable Care Act had provided solid solutions to our current problems. But the compromises needed to pass the ACA left it littered with holes—including a lack of effective cost-controls that threatens to undermine the entire system. Because of these holes, there is one more truth we have to face: however expensive Obamacare was initially, we still haven’t paid the full price.