Although most pundits expected the 2012 presidential campaign to focus on the economy, the central theme that has emerged has been the candidates' profoundly different views on the role of government in our lives. For health care, this dispute centers on whether the federal government should finance access to health insurance coverage and on how much to rely on market forces—or government—to restrain growth in health spending. Yet, politics has a way of softening sharp, ideological differences. Our federal government system, with its multiple layers of often arcane checks and balances, limits decisive policy departures and tends to reinforce the status quo even when the status quo is highly imperfect. Politics can trump policy and usually does. For example, it was politics and not policy that lead Romney to repudiate running mate Ryan's House budget, which adopted the same $718 billion Medicare payment reductions that were in Obama's Patient Protection and Affordable Care Act (ACA).