Democrats cannot limit themselves to defensive efforts to salvage the Affordable Care Act at either the federal or the state level. They need to think about a more attractive national agenda in health care that reflects the lessons of the ACA and new political realities. The coming national Democratic debate is going to focus on extending Medicare—to whom, how quickly, and under what rules will be the questions.
We are now on the verge of one of the greatest U-turns in the history of national policy and politics. It may well change the basic workings of our government and private institutions and the role of the United States in the world. The impact is likely to be profound. Since government is a national looking glass, Americans will see themselves reflected in their government in an altogether different way from the Obama years. Many will look at that reflection and insist, “That’s not who we are.” But to the world—and to many Americans—that is who Americans will be, unless we organize and resist.