The national political debate on health care is stalled on access to health insurance. Politicians may be smart to stop and listen to concerns by Americans with health insurance about higher deductibles, rising medical costs, surprise hospital charges and uncovered long-term care expenses.
Americans are feeling the pinch of escalating health insurance premiums and medical costs. This expands the anxious audience to people with health insurance as well as people with no coverage.
The political potency of health care costs was demonstrated in the 2018 mid-term elections as Democrats swept back to control in the House. The issue is expected to loom large again in the 2020 presidential election.
The debate, which rarely descends below the superficial, pits Medicare-for-All against a vague promise from Republicans of something great and affordable. President Trump has pledged, as he has before, to unveil major health care legislation in the next few months. Expectations aren’t high.
Oregonians have learned that discussions about universal access to health insurance must be accompanied by a serious conversation about how to control health care costs. Access to an unaffordable health care system isn’t materially different from no access to health insurance when it comes to paying huge bills.
Former Oregon Governor John Kitzhaber provided teachable moments on confronting costs embedded in the health care delivery system – long-term care for low-income older adults, lack of behavioral resources, inefficiency in treating chronic disease and failure to address social determinants that lead to a lifetime of outsized health care costs.
As prescient as Kitzhaber’s perceptions have been, health care costs in Oregon and elsewhere continue to rise. And the health care delivery system remains uncomfortably uncoordinated and sub-optimized, as even health care professionals acknowledge.
Democratic presidential candidates have jumped on health care as a seminal 2020 campaign issue. However, the political cure Democrats offer may miss the mark.
“The Democrats’ emphasis on Medicare expansion plans is partly a missed opportunity and partly a reflection of the slice of the electorate that participates in Democratic primaries,” according to pollsters and political strategists. The concern of a majority of actual Democratic voters in 2020 may center instead on issues such as the price of drugs like insulin, exploding co-pays, unaffordable health insurance premiums and the uncovered costs of long-term care for older adults.
The efficacy of health care on the campaign stump has prompted President Trump to return to the issue, which previously resulted in an embarrassing loss on the Senate floor when the late Senator John McCain torpedoed a GOP-backed repeal of Obamacare. It remains questionable whether Republicans can identify a center-point on how to move beyond the Affordable Care Act.
Democrats stand on the same political quicksand. Senator Bernie Sanders has pushed his Medicare-for-All legislation, which would cashier private health insurance, expand existing Medicare benefits and require substantial additional revenue. Moderate Democrats have pitched a public option under Obamacare to create competition for private health insurance plans. There are variations, often with vague details, somewhere in between.
Rising prescription drug prices also have galvanized American political discontent. Trump has flirted with actions to reduce drug prices, but has achieved nothing definitive to brag about, at least so far, heading into the 2020 election. Congress is acting on bipartisan legislation to address prescription drug prices, but it is too complex to translate into news coverage or the national consciousness. Drug pricing has risen to the level of a special work group evaluating the US-Mexico-Canada trade agreement.
Tellingly, Senator Elizabeth Warren, easily the most cerebral 2020 Democratic presidential candidate, has a “plan for that” for almost every issue except health care. She has stopped short of embracing Medicare-for-All. Her hesitancy is perhaps the surest indicator that health care reform is a systemic idea requiring a sophisticated response that doesn’t fit on a bumpersticker.
The big idea for health care reform in Congress may remain a puzzle or, if known, a hidden secret. Chances are the ultimate successful idea will need the embrace of significant parts of both political parties. Its revelation is unexpected along the 2020 presidential campaign trail.
However, the 2020 electorate may erase any doubt Americans of all political stripes want a national health care system that is better than the patchwork system now in place. The presidential election may serve as a political sounding board that health care should rise above partisanship. A logical, sustainable response would require the forbearance of both political parties – and partisan apologists.
The American solution to health care may not resemble anything anywhere else. Its test will be whether it delivers affordable and accessible health insurance, health care delivery, prescription medications and new technology. It is a tall order, but the person, political party or organization that conceives of that system may reign supreme in the public’s mind for a generation or more.
As flawed as Obamacare may be, it stands as a testament that any improvement can be a legend-making milestone.