I’ve listened to a few Democrats speaking about health care over the past week and this survey of solutions that Vox obtained from some Senators really alarmed me. It just seems that this is a great time to not just oppose the ACHA, but also to present an alternative so that people can hear how Democrats would approach fixing the ACA. Perhaps you are hearing better discussion from Democrats — I still don’t have TV so have no idea how they perform in the talking head space.
But there has to be solutions and ones that people will easily understand will help them. Here’s some ideas:
- Single Payer or at least Medicare for All. I get that there is not enough D support for this in either the House or the Senate. I will ask Dems to remember their grassroots here. We’ve been out in front of everything positive that has happened since January 20th and it is time for you to support us. And you need a North Star here. I have been listening to some reporting from NPR on health care in places where the “white working class” you are supposed to be talking to live and THESE Trump voters are talking about a single payer program.
It is well past time for Dems to get in front of this (and other economic) train. Americans need a serious fix to the health care problem and this is it. Buying into more half measures (like the HSAs Susan Collins has been talking about this weekend) is not a viable fix. All it does is make the owner of the HSA responsible for cost control. Getting 3 bids to treat a stroke is not an option. Single payer or Medicare for All might be impossible right now, but we need Dems all over to talk about this as a goal. Because you are ceding the messaging field to Rs who are busily trying to paint this as the worst thing since Communism. Your North Star CANNOT be unhappy fixes to Obamacare. You have to be pointed at a real solution, with real benefits to the Americans who need it.
- If we are fixing the ACA, then adding a Public Option or a Medicare Buy-In is a Must Have. Tell people that this will make sure that there is at least one option for insurance everywhere in the US. And may get insurers attention in terms of cost.
- Subsidize more insurance plans — this is how Medicare Advantage got fixed and works and even though the subsidies have decreased recently, the plans are popular and fairly robust.
- Let insurers move high risk patients to a pool outside of the regular insurance pools — the high risk pools or some reinsurance pool. Reinsurance could be funded by the Feds or some combo of the Feds and the insurer — this doesn’t matter as much as communicating that you are open to helping insurers to reduce their premiums to you. This would mean that the cost of very sick ACA patients have a smaller impact on the premiums for the larger insurance pool.
- Drop the idea of eliminating Medicaid or shifting it to states.
I’d be OK with a robust fix to Obamacare and the above bullets count as robust to me. If anything because there are a very great many insured who are at some risk of not being insured soon. And we have to make sure these people are taken care of. Insurance does work — but it works if you create a big pool of insured, and if at any given time only relatively small percentage of the insured are actually utilizing it for large bills. We also have to remember that insurance works if the providers aren’t incentivized to milk the system. Cost control has to be part of the long term fix, which is why I would just talk about Medicare for All. It is not a perfect solution, but most people understand how rates are set for Medicare and how that keeps the program robust.
Democrats need to be able to talk about what health care would look like if they were at the table or running Congress. They need to do that NOW. Bipartisanship is not your goal here — getting as many Americans access to the health care they need is. The good news here is that everyone wants to hear a solution and they ARE NOT HEARING ONE FROM THE GOP. And you must talk about it clearly and cleanly with a minimum of wonk-ese. If you sound like you are putting your finger in the wind and trying to minimize your risk, this is what people hear and will never trust that you will do what you say. Be clear, state your plan and then expand as you need to.
I don’t know what it would take for Democrats to get on the same page here, but we have to do much better than you have. Tom Carper’s performance on MTP provided me with no sense that he even understood the magnitude of the problem (much less a fix for it) — just that he wanted bipartisanship. I listened to Tom Perez a few weeks ago talk about fixes to ACA and he gave a mushmouthed answer too. Pick a solution, y’all. Get your elevator pitch down and start making your case for a better government with Democrats at the helm.