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Health Reform: What Next?


  • Alice M. Rivlin is senior fellow in the Economic Studies Program at the Brookings Institution and visiting professor at Georgetown University. She was founding director of the Congressional Budget Offi ce, vice chair of the Federal Reserve Board of Governors, and director of the Offi ce of Management and Budget. She also was a member of the Simpson-Bowles Commission (National Commission on Fiscal Responsibility and Reform) and co-chair of the Domenici-Rivlin Task Force on Debt Reduction. E-mail:


The political rhetoric of the 2012 election suggested that Americans are deeply split over how to deliver and pay for health care. In fact, however, the election may have cleared the way for substantial reforms in health care delivery that will gradually enable the United States to finance effective health care for almost everyone at a sustainable cost. The election affirmed for the first time that almost everyone in the United States will have health insurance coverage and put to rest the idea that voters will tolerate radical change in the complex patchwork of health care financing that has evolved in the United States. The tasks remaining are improving the quality of health care delivered by increasing care coordination and reducing the growth of costs by moving away from fee-for-service delivery toward rewarding quality and value. These challenges are daunting but less ideologically fraught than health coverage expansion.