The midterm elections are over: the Ds control the House and the Rs retain the Senate. And healthcare was the number 1 issue among voters according to multiple polls and analyses. But what does this really mean? The election seems to have solidified the position of the ACA, preventing further Republican efforts in Congress to repeal the law. Furthermore, voters in Idaho, Nebraska and Utah passed ballot measures to expand their Medicaid programs. These changes reflect the benefits of Obamacare: protection and stability for low income individuals who get subsidies for premiums and co-pays, and the guarantee that no one can be denied health insurance for individual insurance. The insurers are also big winners: the stocks of major insurers and healthcare systems jumped after the election, reflecting improved prospects for growth in this current environment. However, these feel like partial victories with painful side-effects. As Bob Laszewski points out, the ACA has devastated the middle class individual insurance market and neither party understands that voters want “insurance security.” Seems like we are far from a shared vision for dealing with the great social and economic challenge of our times. In casual encounters, no one seems satisfied: personal exposure to devastating high bills remains real; service levels continue to disappoint; and entitlements, including the subsidies, appear unsustainable. To deal with the cost and service of the care itself, I place my hopes in a return to the American way of fostering many small-bore approaches, through private entrepreneurship, risk-taking individuals launching new ventures that meet the needs of our diverse population, all of which slowly but surely chips away at the self-serving legacy systems.