Yes We Can? The New Push for American Health Security

What are the prospects for meaningful reform of U.S. health care? To answer this question requires understanding why previous reform efforts (and in particular the 1993 Clinton health plan) failed—the combination of deep structural biases against large-scale public provision and the inherited constraints posed by the rise of employment-based insurance. Generally, the context is more favorable today than it was fifteen years ago. But the prospects for change hinge on learning the right lesson of history: Politics comes first. Putting politics first means avoiding the overarching mistake of the Clinton reformers: envisioning a grand policy compromise rather than hammering out a real political compromise. It also means addressing the inevitable fears of those who believe they are well protected by our eroding employment-based framework. And it means premising political strategies on the contemporary realities of hyperpolarized politics, rather than wistfully recalled images of the bipartisan politics of old.