Health Reform Has Stalled — Here Is a Governable Alternative
Progressive overhaul failed to pass, partial reforms lapsed, and rollbacks erased gains. A third path is now the only governable option.
After years of gridlock and policy whiplash, neither party can deliver durable health reform. What follows is an alternative that can.
For fifteen years the United States has circled the same health-care arguments without resolving them. We have expanded coverage only to watch reforms expire or get repealed. We have substituted fiscal brinkmanship for policy design. We have allowed people to lose coverage whenever their job changes and to face financial ruin even when they are insured. Democrats cannot agree on a plan that can pass, and Republicans have abandoned reform altogether. The governing system no longer produces durable health policy.
This paper was written in that context — in the middle of another fiscal standoff in which health care, wages of workers and many fundamental government services are once again collateral damage.
It is not a call for single-payer or a defense of the status quo. It is a proposal for a third path: a workable, non-radical, durable reform that preserves private insurance while eliminating its most predictable failures.
Executive Summary
The U.S. health insurance system is failing in predictable and fixable ways.
Coverage is still lost when work changes, even though job transitions are now a routine part of modern labor markets.
Millions with insurance still face unaffordable deductibles, denials, and delays that defeat the purpose of coverage.
Junk plans continue to re-enter the market whenever regulation eases, exposing people to catastrophic risk.
After more than a decade of debate, both parties have held power — and neither has produced a durable or stable framework.
The structure of the two-party system is now itself an obstacle to progress. Democrats are divided between a single-payer vision that cannot pass and incremental ACA expansions that repeatedly expire or are reversed. Republicans have chosen tax cuts and rollbacks over coverage protection, restoring short-term plans and weakening Medicaid and exchange supports. Nearly every gain of the past decade has been temporary, reversible, or undone. Health care is now collateral damage in fiscal warfare.
A third-party governing lane is the only viable path to durable, non-radical reform. The choice is not between a disruptive single-payer overhaul and a return to pre-ACA instability. A sustainable alternative can preserve private insurance while removing its most harmful failures.
The reform consists of four pillars:
· Let employer subsidies follow workers onto exchange plans so coverage continues through job transitions.
· Modernize Flexible Spending Accounts by ending forfeiture, broadening eligibility, and using credits instead of deductions.
· Cap high-risk claims and shift the excess to Medicaid to hold premiums down.
· Create real consumer protections — wider access, limits on denials, and elimination of junk plans — made feasible by the new risk-sharing structure.
This is a feasible reform package, not an ideological wish list.
It works with existing structures, reduces reversals by lowering partisan stakes, and creates a stable, predictable rule set for employers, patients, and insurers.
The two-party system has shown it cannot deliver durable health reform. The only path forward is to support a governing lane committed to stable, permanent, incremental change rather than continued stalemate.
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If you found this executive summary useful, I am developing a series of follow-ups — including concrete third-party planks on other policy areas and a longer, fully-documented version of this health care paper.
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The Approach Forward on Health Care
The U.S. health insurance system remains plagued by persistent problems: loss of coverage during job transitions, rising out-of-pocket costs, proliferation of junk insurance, limited access to specialists, and growing reliance on prior authorization and claim denials.
