The 2020 election and its aftermath promise to escalate an already heated health reform battle.

In his new opinion piece for The Hill, Commonwealth Fund President David Blumenthal, M.D. draws from history to lay out the political conditions that are necessary for major health reform to pass. Among them: a Democratic supermajority, and a committed president who understands the mechanics of Congress and possesses the charisma to amass popular support for change.

Given the daunting challenges of enacting reform, Blumenthal advises that the candidates — as well as other proponents and opponents of reform entering the fray — would do well to understand the historical battlefield on which they will be fighting.