There’s a great line in 2014’s “Godzilla” that I thought about during the last Democratic debate, as the candidates turned to health care. To set the scene, humanity’s had a pretty bad day, which is kind of standard in Godzilla movies.
We just found out that earth was home to not just one enormous, radiation-charged, city-sized creature, but that there were two more. Worse, those new ones were looking to settle down and start a family.
In the most far-fetched part of the film, the monsters somehow find real estate and nest in San Francisco. Right as everyone’s scrambling around trying to figure out how to stop all of these creatures, one scientist, played by Ken Wantanbe, dramatically looks out into the middle distance and says, “The arrogance of man is thinking nature is in our control, and not the other way around.”
Honestly, it was a pretty direct shot at the guy lounging in an air-conditioned theater munching on buttered popcorn. Then the scientist says, “Let them fight.”
That’s basically how I’ve felt about health policy this summer. This summer’s blockbuster — at least in the wonky world of Washington — has been nearly eight hours of Democratic presidential debates and, specifically, the Great Democratic Health Care Debate of 2019.
For those hours, and countless more on cable news, we’ve watched Medicare For All and the Public Option clash in a pitched battle while health care experts desperately try to explain and provide context as they dodge falling debris and blasts of atomic breath.
Like a good movie fight, there’s a lot of noise and yelling and it can end up being pretty disorienting if you sit too close to the screen. So here are a few pieces of advice in navigating the health care debate in the Democratic primary. First, don’t lose sight of the main plot.
One party in the United States continuously proposes health care plans that would help more people get covered while trying to bring down costs. The other party is still on a decade-long quest to destroy the only law protecting people with pre-existing conditions, whether or not they have a replacement ready, primarily because of their political opposition to the people who passed it a decade ago.
That’s the real choice that the voters will face in November of 2020. Second, the conversation in the primary matters, but mostly in its broad strokes. On a conceptual level, this is arguably a more consequential health care debate than the Democratic primary in 2007. In late 2007, for example, as the Democratic primary was mere weeks away from its first caucuses, the three major candidates released their health care plans.
They were nearly identical.
Today, we have a real choice, and there’s evidence for both sides. Do you think that the market will get better if the government provides the right guidelines and guardrails? If so, you might look at the history of the health insurance marketplaces and see that, after a rocky debut, most insurance companies have figured out how to price their insurance in a new market where they can no longer pick and choose the healthiest customers. You might see a market that can change if we put the right incentives in place, and believe that a public option could provide that change.
On the other hand, maybe you think that the real lesson of the Affordable Care Act is that clear, explicit government involvement works – like a clear regulation that forbids insurance companies from denying health insurance to anyone or charge them more just because of a pre-existing condition. You also might see that about half of the expansion of health insurance through the ACA came by expanding public insurance programs like Medicaid. Maybe Medicare For All is the blunt instrument we need.
Each of these is a point on a spectrum, and the candidates right now are navigating the space in between. That’s why, finally, you should keep in mind that these plans will change. The candidates are hearing from voters, working with policy experts, and learning from conversations on the trail, picking up ideas and nuances about what works and what doesn’t.
And then, eventually, Congress will get involved — and Congress matters. The only reason we’re still debating a public option today instead of reviewing how many people enrolled in it this year, is that then-Sen. Joe Lieberman, D-Conn., didn’t want the ACA to include one.
So what should you pay attention to? Each plan, and the rollout around it, is like a lens through which you can more clearly see the candidates. You can see how they approach issues, what principles are most important to them, and most importantly, given the history of the Affordable Care Act, how well they can talk about complex policy decisions.
Drew Altman, the president of the Kaiser Family Foundation, put it well in a recent op-ed, “What voters really need to know is where candidates would take the health system, how they differ from other candidates on direction and basic choices and what that says about the kind of president they would be.”
If your real concern is how to make health care better and more affordable in your community, the election for the General Assembly this November is a better place to focus. Not only do state governments closely regulate and monitor their state’s health care system, but they’re usually the front line for any major reforms.
And then, once you get through that election, find out who’s running for Congress in your district and ask them about their plans for improving health care. Politics isn’t the only thing that’s local; health care is, too.
As for the grand battles and debates on the presidential primary stage? Just let them fight.