The cost, complexity, coverage, and quality challenges have combined to make healthcare the No. 1 campaign priority for voters. Complaining about the current healthcare system might get audiences lathered up, but candidates should be forced to describe and defend their alternatives to the current system.
For the next several weeks, we’re going to take a look at what I’m calling “treatment options” to cure the symptoms of the current healthcare system for voter consideration. The proposals can be categorized according to political belief. The political positioning drives the beliefs regarding the amount of change needed to cure healthcare’s ills:
- Far Left—Those on the far left believe the current system is irreparably broken and should be totally replaced with a government system because healthcare is a right for everyone. Medicare for all is the only logical option for those on the far left. To put it in medical terms, they believe a complete transplant of the healthcare system is the only option.
- Center Left—Those on the center left believe the Affordable Care Act (ACA) can be fixed by a further expansion of the federal government’s role and influence in healthcare. The private healthcare system has failed in expanding affordable access to health insurance; therefore, the federal government needs to step in with public insurance programs where the private system has failed. Medicare for more, or similar public-plan options, are the preferred pathway for those in the center left. I would categorize their recommended treatment in medical terms as an inpatient surgery.
- Center Right—Those in the center right believe that the combination of private innovation and consumer engagement will lead to the most-efficient and highest-quality healthcare system. Quietly, this group admits that the coverage expansions and preexisting-condition protections within the ACA are politically popular and that the group can no longer afford to publicly fight against the ACA. Additional private-plan flexibility through things like tax-preferred accounts are popular with the center right. In medical terms, the center right recommends a minimally invasive outpatient procedure followed by a bit of physical therapy.
- Far Right—Those on the far right believe that the ACA is an unconstitutional government overreach into healthcare and that the ACA is a major contributor to our cost problems. If the government would decrease its overregulation of healthcare, then the free market would improve care quality and cost efficiency. “Repeal and replace” is still alive as a dream for those on the far right. Theirs is the medical equivalent of take two aspirin and call me in four years if you don’t feel better.
Multiple approaches to transforming the American healthcare system are actively discussed and debated in Washington, DC, with influence from those across the political belief spectrum. Organizing the issues and options in an understandable way is a massive challenge for the voter who does not work in healthcare financing every day. The primary issues and options surround coverage, prices, and the role that government, employers, and individuals play in financing the system.
- Universal Coverage or Universal Access—Universal coverage means everyone has health insurance. Universal access means everyone has the choice and option to have health insurance. The ACA granted universal access—no American can be turned down for health insurance—but the ACA came well short of the universal-coverage goal, in which every single American has health insurance. Does the plan cover everyone, or does it give everyone the choice to be covered?
- Government Regulation of Healthcare Prices—The government already regulates insurance prices and medical-loss ratios through the ACA, but the ACA did not address the price of healthcare services. Many currently debated proposals have the government regulating the prices paid to medical providers. What role does the federal government play in setting prices for healthcare services?
- Single-Payer System or Public-Private Partnership—In a single-payer system, the government acts as the sole administrator. As an example, the IRS is the sole administrator of the tax code. In a public-private partnership, public programs coordinate with private programs to create options. Medicare is currently an example of a public-private partnership, where 80% of Medicare participants have some type of private insurance to supplement or replace traditional Medicare coverage. Is the government’s role to be the sole administrator or the administrative foundation?
- Employer-Sponsored Health Insurance Stays or Goes—More Americans get their health insurance through their employers than through any other source. Some proposals maintain some type of employment-based coverage to keep a sense of stability for working Americans and to decrease or avoid the need for new taxes. Others eliminate the role of employers rather than paying a tax to fund the system. Should employment impact your health insurance coverage options, and how should employers pay for healthcare?
- Participant Cost Sharing—Some plans have no premium or cost sharing; these plans often get described as free health insurance. All funding for these plans comes through new taxes and fees. Other plans try to avoid the full burden of new taxes and charge participants for coverage and care. What is the appropriate and acceptable level of participant cost sharing?
We’ll be taking a look at all of these “treatment options.” Up first is Medicare for all.
Medicare for all is a term that gets thrown around a lot. It’s popular, but let’s be honest, it’s confusing. Next week, we’re going to take a look at what it really means to you and your insurance coverage. Tune in to find out more. And, if you haven’t already, I encourage you to sign up for the “Insiders’ Club” where you’ll be notified when I release new information on my book “The Voter’s Guide to Healthcare: A non-partisan, candid, and relevant look at politics and healthcare in America.”