Conservative obstinacy is driving me towards this conclusion...

Something I've always resisted, since I hoped an American, really mixed-model could be found that would successfully control costs, expand coverage, and maintain quality. Unfortunately, conservatives have moved so far to the right (or more accurately economic crazy-land, since many Republicans just 20 years ago would have laughed at the current nonsensical right-wing thinking), that they clearly have no interest in improving the most viable mixed-market model incorporating most of the best health care policy thinking of the last several decades- i.e. PPACA. If a mixed-model like PPACA being implemented is so risky (in that it's never been successfully done comparatively), and Republicans aren't going to support it no matter what, then I question whether it makes sense for Democrats to continue to try this approach if it doesn't pretty quickly show promise. I know politically it seems unlikely to be possible, but from an analytic standpoint, it's quite clear that if the U.S. wants to control costs (and luckily also expand coverage and maintain quality), then the U.S. should dramatically expand the government's role in health care. Either dramatically increase the sector's regulations to something like Switzerland, Germany, France, etc. levels, or just nationalize it like the British system (I'm not necessarily a fan of the single-payer, or weaker public option, model like Canada- just because I think the other alternatives are better in the long-run. If we're doing big government, let's do it the best way possible).

It's been years since the health care reform debate really heated up, and so far Republicans and conservatives have mostly stuck to the few ideas Obama and Democrats didn't include in PPACA- things like HSAs (an appropriate decision here, since they have numerous flaws and in many ways worsen conditions in the health care sector) and tort law reform (which the most generous analyses find you'd be lucky to get a one-time 1% decline in overall health care costs, even including savings from reduced defensive medicine). The only new thing (for Republicans, since it was always a wonky liberal policy idea) discovered is the premium support model, which is largely a cost-shifting proposal with limited cost-saving potential at the level Ryan proposes. Hence leftish-wonks favoring much higher growth rates than Ryan proposes in the premium support annual updates, because sensible policymakers don't suggest placing the burden of sky-high health care costs and deficit reduction on the elderly. For successful implementation, the premium support model also requires significant market reforms and regulations that Republicans now frequently resist (likely because Obama had the audacity to include them in his PPACA reforms). Anyways, this health care debate is getting old, Republican ideas are getting stale, and the inability of private solutions to solve the health sector's problems (due to obvious free market assumption violations for health care) is becoming increasingly clear. PPACA is the law-of-the-land, and if you want a strong private role in American health care, than you should actively be working to improve PPACA by strengthening it- not repealing, replacing, or weakening it. If it doesn't work, then people should get out of the way, because the American public will force the government to step in to take on a European-level role in health care. Especially once they wake up and realize that other countries have had cheaper yet superior health care systems for almost a century (by the time this kind of reform is likely). The American people simply won't accept a deteriorating health care market forever. People prematurely dying in large numbers from a lack of health insurance tends to focus the public.