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.
