What Dems Want To Do On Health Care — And What They Actually Can
Lots of need out there and lots of ideas for addressing it. But only so much money and so many votes.
I spent most of the Obama administration writing about access to health care. Partly that’s because the subject is such a big interest to me. Partly that’s because it was usually at the top of the agenda, especially during the first year when Democrats were deliberating over what became the Affordable Care Act.
Things are different right now. The pandemic means we’re talking a lot about medicine and public health, for sure. But that’s a separate set of issues, for the most part. And when it comes to Congress, the focus is on voting rights plus the massive spending bill that includes major proposals for climate, education and child care. Improving access to health care would be just one piece of that package.
But it would be a big piece and probably a lot bigger than you’ve heard. My new story at HuffPost offers an overview of the major items Democrats are now contemplating — and the political dilemma they face as they try to put them in one bill. It is based on conversations with more than a dozen insiders, on and off Capitol Hill.
The list of initiatives includes…
1. Extending temporary improvements to the Affordable Care Act, so that people buying coverage through HealthCare.gov or state exchanges like Covered California can get lower premiums and out-of-pocket costs.
2. Upgrades to Medicare, like adding dental, vision and hearing benefits, and making the program available to people when they turn 60, 55 or maybe even 50.
3. A big investment in home care and community-based supports for the elderly and people with disabilities.
4. Coverage for low-income people in a dozen states where Republicans haven’t expanded Medicaid eligibility, even with the federal government picking up nearly the entire cost.
Of course, all of these initiatives would require significant increases in government spending. Together, they almost surely add up to more than Democrats are willing to spend on health care, especially with so many other, non-health items on the agenda.
That’s going to force some difficult choices and questions.
For example, is it better to spend a marginal dollar on Medicaid expansion, because that goes directly to the most economically vulnerable parts of the population — and because we know, from research, those people will see substantial benefits?
Or is it better to focus on improving or expanding Medicare, on the theory that it moves us closer to a “Medicare for All” system (or something like it) and that such a system offers the best hope of both guaranteeing access and controlling costs?
Reasonable people with similar values can disagree about the answers to these questions — and they are disagreeing, right now, as Democrats argue over what mix of policies to include in legislation.
Still, the level of sniping within the Democratic coalition now is remarkably low. Each of these initiatives has its dedicated advocates. But at least in conversations with me, they all focus on talking up their initiatives, rather than talking down others.
One reason may be a recognition that, ultimately, any of these ideas would address a real need. Another reason may be that, after four years of staring into the abyss of the Trump era, Democrats and their allies have a pretty strong sense of solidarity and shared purpose.
One final reason, I think, is a recognition that they are cooperating on one particular element of their agenda: Prescription drug reform. Getting down the price of prescription drugs would save the government money, freeing up resources to finance the other initiatives. But to do that successfully, Democrats have to overcome the power of the pharmaceutical industry, one of the most influential in Washington.
It’s doable, maybe, but only if advocates stick together. And I think they know that.
Here’s a link to my new article.
Thanks for reading!