According to Pew research, health care was the single biggest worry on the minds of the people as they cast their ballot. With large Democratic wins, control of the House and a pickup of seven Governorships, the people have spoken. Health care is a mess and they want it fixed. With President Trump and the Republican controlled Senate, what can the Democrats do to move the needle on fixing our health care system?
Many of the winning Democrats ran on the mantra of Medicare for All. Considering a recent Reuters survey of the public showed that almost 85% of Democrats and 52% of Republicans support the idea of Medicare for All, that was probably a good move. Had the Democrats won the Senate too, they might have convinced the mercurial Trump to go along with Medicare for All legislation. But, alas, that will not come to pass.
It is a good thing in the short term that Medicare for All will not be put forth. Massive legislation needs the support of a super majority to actually work – this is why social security and the original Medicare were so successful. Although there is close to a super majority in the population who support Medicare for All, the current makeup of our leadership would make it a no-go.
The Affordable Care Act barely passed by the skin of its teeth. It was a workable plan that contained both Republican and Democratic ideals and could have been successful if implemented correctly and fixed along the way. The initial compromise of not including a public option to purchase policies similar to Medicare was the first mistake. The continued sabotage from the many who did not support it resulted in further erosion of the effectiveness of the legislation and caused health care costs to spiral upward.
The Affordable Care Act had provisions that would have somewhat reduced the cost of our health care system had it been enacted correctly. However, the primary goal was to first expand coverage. By expanding coverage without doing much about the cost of health care, we ended up in the boat we are in today. People are suffering, the Republicans have not come up with a workable solution to fix the health care system, and that is why people are looking at Medicare for All.
The populace is sick of back room dealings and legislation pushed through in the dark of night. Both sides have been guilty of this and the tactic seems to becoming more prevalent. People want transparency, authentic truth telling, and common sense solutions. This is what the Democrats need to provide.
Between now and 2020, while Democrats transparently create well thought out legislation for Medicare for All, they can begin the repair of the health care system. It does not take massive legislation to do this. Here are some examples.
- Make balance billing illegal. Balance billing occurs when a patient receives out of network coverage in surprise situations such as emergencies or hospitalizations. There is already legislation in the works and they need to make sure this is passed.
- Require price transparency for all health care services at the point of service. The Republicans want free market health care so people can shop wisely for the services they need. Sadly, they have only given lip service to creating legislation that requires price transparency from health care providers so patients can shop effectively. It was bundled in the massive Republican health care legislation last year. As a stand-alone bill, it would be a no-brainer.
- Allow the government to negotiate drug prices for Medicare Part D beneficiaries and other public programs. This has been bantered about for years. The pharmaceutical manufacturers spend significant money on politicians, with Republicans receiving almost two-thirds of their largesse. President Trump has talked a big game about this and now it is time to make him deliver.
- Rebuild our primary care system. Countries with healthy primary care systems have better care at a lower cost. A major objective of the Affordable Care Act was to rebuild primary care. It greatly expanded the funding of community health centers and provided incentives for more people to enter the primary care workforce. Unfortunately, these features of the ACA were cut significantly when the Republicans gained the House in 2012. We can restore these two objectives as stand-alone legislation.
- Create one nationalized electronic medical record built on patient care, not billing. The current electronic records are strangling medicine. By having one easy to use record that is open access to the patient, we can improve care and greatly reduce cost and bureaucracy.
- If the Democrats are feeling particularly emboldened, they can propose to provide primary care as a public service for all through community health centers. This would be a big relief valve for the majority of people who just need basic care so they can stay healthy, work, and avoid higher cost care. This would allow the removal of primary care from insurance coverage and bring back truly catastrophic plans at a lower cost and if the Democrats win in the future, prepare the bed for Medicare for All. I’ve written about this frequently. As an added bonus, these centers can also act as centers of preparedness for epidemics and bioterrorist events.
There is much to be done. I’ve long called health care reform a continuing soap opera. I want our health care system fixed so I can quit watching the show, and hopefully we can make some inroads over the next couple of years.