Analysis & commentary. Health reform: only a cease-fire in a political hundred years' war

Four dominant political forces drove the process and product of national health reform during the past two years: federal budget constraints; public concerns about the size and reach of the federal government; the time pressure of the congressional calendar; and the political parties' high-stakes, all-or-nothing bets on what became President Barack Obama's defining policy priority. Republican congressional leaders saw little advantage in offering more detailed alternatives. Congressional Democrats calculated that they had even more to lose politically by abandoning health reform legislation than by pushing it through Congress. This essay argues that passage of the legislation merely represents a cease-fire in a long-standing war and that more battles between forces for "implementation" and those for "repeal and replace" are to come.