The new health insurance market places—the exchanges set up under Obamacare—have become the hot health policy topic.  Will they work or won’t they?  The focus is on the near term.  And no one should doubt that what happens in the next few months is extremely important—as former cabinet officer Wilbur Cohen said, good policy is 1% inspiration and 99% implementation.  Vital though near-term effectiveness is, the exchanges hold a longer-term potential—they can help reshape the organization, delivery, and financing of insurance.  Simply put, we think that the health insurance exchange—supported at various times by both liberals and conservatives—may well fulfill the health reform dreams of both.  To see why, one need only recall what conservatives and liberals want.