No one knows how this government and political failure will play out, but whatever happens is likely to shape the healthcare debate in 2021 and beyond. Determining how universal health coverage will be paid for has actually always been a challenge. The ACA ducked the issue by developing on the existing structure while leaving its injustices in place.We participate in wonderful believing to have somebody else spend for it: our companies, insurance provider, or the "government." Bernie Sanders told us that we would pay more in taxes but less in premiums and out-of-pocket expenses, and therefore we would come out ahead in the end. Nobody believed him.