The next big shift is coming in U.S. health care, and Republicans are doing their best to speed it up. What's not clear is how carefully they've thought through the consequences. A defining feature of U.S. health-care policy is that most Americans get insurance through their employers. That has frustrated liberals' attempts to rally voters behind Obamacare's modest reforms, let alone the single-payer model that works so well in most developed countries: The average person has no incentive to support changes that might jeopardize their situation.