I haven’t been tweeting or commenting much about either (all if we count O’Malley) of the Democratic candidates’ proposed health care plans. You may think that’s odd for someone who spent two years fighting for national health care reform and who devours health care policy information for fun. But truth is I believe – as someone who fought for health care reform – that either candidate’s stance will be just fine. Here’s why:
I know both Clinton and Sanders will protect the best of the Affordable Care Act, but neither will be able to get much done to improve upon it without full control of both the House and Senate.
When I started heading up communications for Health Care for America Now (HCAN), we fielded a lot of frustration and a decent amount of full-on anger from staunch single payer advocates. They didn’t understand why a giant progressive coalition wouldn’t start the fight for change from the farthest left stance possible. What I learned and had to explain time and time again was that there is so much deeply engrained fear of change when it comes to health care in this country that proposing something like single payer to the general public would have been a nonstarter in 2008. Add to that the stranglehold the massively influential medical industrial complex has on 17.5% of our nation’s GDP, and we would have been facing sudden death. There wouldn’t have been a negotiating table at all.
You may not remember (oh, but I do) that candidate Obama spent 80% of his advertising budget in October 2008 on ads featuring his health care plans, and those plans emphasized the middle ground between single payer and the private insurance-dominated status quo. That middle ground included setting up a marketplace where people could comparison shop for health insurance plans, including a public option that would serve to control costs and keep private insurance companies honest (ish).
The public option fell by the wayside in December 2009, an ugly casualty of the reality of how laws make their way through Congress. In other words, I’ve seen how the health care reform sausage is made, and it’s not appetizing.
So while I have come to appreciate the benefits of a single payer system and wish we could get there, I know it’s not a realistic outcome in the short term. I get what Sanders is going for, and I’m down for his optimism. I can respect his desire to get the message across that the system we have now is abusive highway robbery at best and deadly at worst, and we can do better. And I also adore his emphasis on the truth that without campaign finance reform, we’ll never get out from under the shackles of big money buying elections and elected officials. I even can vote for it.
But just like President Obama had to change course once he faced the reality of Congressional pushback so would Sanders. All the Presidential will in the world can’t move a stubborn, bought-and-paid-for Congress.
As for Clinton, she’s intimately familiar with the challenges of making any national health reform improvements, and she’s attempting to convey that on the campaign trail. Personally, I wouldn’t mind hearing her be a little less practical and a little more aspirational, but I get it. She knows the game, and she’s aiming to keep expectations low.
Health care reform was a heavy lift, and I don’t expect it to be as high a priority for the next Administration as it was for this one. I think it will be considered a second tier issue compared to the plethora of other economic and national security concerns we have facing our nation at the moment. As much as I love it, and would gobble up every ounce of coverage, I’m not counting on it taking center stage.
Elect a Republican, however, and you can kiss all that is working for patients (eliminated pre-existing condition exclusions, expanded parental coverage for young adults, women not being charged more than men, Medicaid expansions, mandatory essential services) goodbye. There is no viable GOP health care plan. Never was. Never will be. Repeal and replace is a farce. It’s just repeal and move along.
And that’s why I am not going to spend too much time digging into the details of either Clinton’s or Sanders’ health care proposals. They won’t really matter. The one thing that will is protecting the work we’ve done up until now and keeping it intact so we can make incremental adjustments and improvements until this country finally hits the tipping point and is ready for wholesale change.
I’m excited for that day, but we’re just not there yet. The key now is voting for your preference in the primary and then supporting whoever wins the Democratic nomination in the general. And voting for down-ballot Democrats too.
President Obama didn’t have the luxury of enough members of Congress willing to fight for what he promised and what we truly needed in national health care reform. Politics killed the details of good policy. This time around, back whomever you prefer in the primary, but then vow to give the Democratic nominee both your vote and a Congress to work with.
Because no matter the plans presented on the campaign trail, with that kind of support, he or she just may surprise you.