The battle for the soul of American health care is not really one of Democrat versus Republican or liberal versus conservative. Rather, it is between competing visions we can call the Fortress and the Frontier.
The Fortress is orderly and static — ruled jointly by political and medical aristocracies. The Frontier is chaotic and dynamic, with no permanent ruling class. For 50 years, federal and state policies have pushed health care away from the Frontier and into the Fortress. The Affordable Care Act (ACA, or "Obamacare") is only the latest instance.