Henry Aaron and Joe Antos took to the pages of NEJM to articulate the current state and future of the health policy debate.* In reading their pieces, I was struck by how little that debate has changed since passage of the Affordable Care Act, and how little it’s likely to change in the foreseeable future.
Henry Aaron reminds us that “most features of the ACA derive from one binding constraint: it had to be an incremental plan.” Why? Because neither liberals’ nor conservatives’ grand visions—single payer and a voucherized individual market for all, respectively—were politically viable for the simple reason that “most Americans were well insured and generally satisfied with their own coverage.”
With respect to the conservative health policy agenda, Joe Antos largely acknowledges this political reality.
[P]olitical realities have constrained the policy options [Republicans have] advanced.
Except, perhaps, in incremental ways, with Obama in office, I doubt health policy will move very far to the right over the next few years. But it won’t move to the left either.
However, Antos holds out some hope if the GOP takes the Senate.
If Republicans gain a Senate majority in the fall […] they’ll probably have more traction reforming Medicare than making major changes to the President’s most personal political achievement [the ACA].
I wonder about this. If Obama wants to hold the line on structural changes to Medicare, he’s got the veto power to do so. On the other hand, if a Republican Congress can hold some crucial piece of legislation hostage until some deal is struck that includes Medicare, maybe Obama will give a little. Really, I have no idea how likely this is.
But one thing is certain, any substantial Medicare change will be very controversial. If Republicans go big, they’ll open themselves up to harsh criticism and potential trouble with senior citizens in the 2016 presidential election cycle. And, I seriously doubt a party can lose because it defended Medicare.
Best guess: We’ll hear lots of talk but see very little action. For better or worse, I’m putting my money on the current structure of health policy being largely locked in at least through 2016.
* Actually, I think their pieces were published online and have not yet appeared on any pages, literally.