One of the themes of my Grand Unified Theory of Health Reform is that a major mistake of the 1994 proposal was that it was policy that mistook itself for politics. By entrusting the construction of the policy to wonks rather than politicians, the Clinton administration chose a process that would elevate technical concerns over consensus-building. It was a terrible error. In the policy, the politics have to come first. And because that will mean, on some level, degrading the policy (particularly in terms of cost control), it's important to think seriously about how it sets up future reforms. Which is why I've begun thinking about the policies less in terms of their specific and more in terms of how well they implement the larger principles that the system needs to move towards.
