I remember during the end of the health care reform fight how top Democrats promised activists unhappy with the bill that they would “fix it later.” I remember being told that it was very important to pass a bill despite many serious problems, design flaws and terrible compromises, because it would be easy to fix those issues later.

Well, it is two years later, and the Democratic Party has basically dropped any pretext that they want to seriously improve the Affordable Care Act. Not only has basically every top elected Democrat stopped even paying lip service to the idea of trying to make the law more progressive, but improving it is basically absent from the Democratic platform. As far as I can tell, this is the only mention in the platform that the ACA may need improvements:

At the same time, the Affordable Care Act is not the end of efforts to improve health care for all Americans. Democrats will continue to fight for a strong health care workforce with an emphasis on primary care. We remain committed to eliminating disparities in health and will continue to make sure families have access to mental health and substance abuse services. We will strengthen Medicaid and oppose efforts to block grant the program, slash its funding, and leave millions more without health insurance. We will continue to invest in our public health infrastructure – ensuring that we are able to respond to emergencies and support community-based efforts to prevent disease.

These are relatively minor issues about increasing the number of doctors and coverage of certain conditions. There is no call for a public option or single payer. There are no calls for adding an early Medicare buy in, as was talked about during the health care debate. There’s nothing about drug re-importation or Medicare direct drug price negotiation. There is not even a reference to the idea Obama previously endorsed of speeding up when states can experiment with better systems.

The platform of the Democratic Party is basically that the ACA is great how it is and there is very little need to improve it.

This is an important lesson about legislative fights. Inertia is an overwhelming force in Washington. Things rarely get improved later even when politicians say improvement is needed. That is why it is so important to fight to get the design right to begin with, or we end of living with the design flaws for a very long time. The bad state/federal partnership design element of Medicaid is still causing major issues decades after it was started.