I used to be a skeptic

I admit that I wasn't thrilled about the Affordable Care Act when it first became law. I had the same objections that most of us with a portside list had. It didn't do enough to contain costs, it left the insurance companies leeching on the system, it was just a gravy train for hospitals and medical suppliers and long-term affordability was highly doubtful.

So far, however, so good. The latest Commonwealth Fund survey finds that it's been a major success in reducing the number of people who are uninsured, reducing the number of people who delay care because of cost, and reducing the number of people who have trouble paying bills or who have medical debt. It's working to make life better for millions of people.

But how about cost? In fact the growth in health care spending has been well below recent experience. There's debate about the reasons for this, but clearly the ACA did not cause an increase in cost. I am now cautiously optimistic that there is simply no politically plausible path for Republicans to destroy the ACA, and given that it is becoming more and more entrenched, the only way forward for Congress is to improve it. As Medicare demonstrates effective reforms in the structure of reimbursement, those changes can be made widespread in the private insurance market as well. If we move from fee-for-service to Accountable Care Organizations, we'll get better health care for less money. And the ACA has created a platform for doing that. Doctors and drug companies and hospital execs may howl, but it will be impossible to take this away from people and that means it has to be affordable. That's the political dynamic ahead of us, I (confidently?) predict.