A plan for better health care

By Brian Chiglinksy

It was all so dramatic.

Half past one in the morning. The chamber of the Senate. Packed with senators, their staff, and plenty of reporters. (It was three years ago, so no one was worried about social distancing yet.)

Suddenly, the room hushed as a single senator walked on to the Senate floor, held out his hand and, like a Roman emperor with a gladiator’s fate in the balance, dramatically gave a devastating thumbs down.

I don’t know if we’ll ever see a single vote in the United States Senate as dramatic as Senator McCain’s vote against repealing the Affordable Care Act. And yet, almost exactly three years later, I can’t help but think it was all so tragic. I don’t mean that in terms of policy outcomes. Each of the six separate repeal bills Congress considered in 2017 would have caused tens of millions of people to lose their health insurance, gutted Medicaid and left Americans without health insurance protections that have been absolutely crucial in a pandemic.

I mean that this was a tragedy of bad governance. For two years, the American people had a rare thing in these polarized times: a federal government unified by party across every branch. Finally, Americans had a government in the ideal position for passing broad, transformative legislation that could make a difference in people’s lives. And yet, with McCain’s no vote, while we saved policy progress that had been made over the past decade, we lost months of valuable time.

 “Time is the only non-renewable resource in a campaign,” former White House Communications Director Dan Pfeiffer recently wrote. It’s true for a government, too. And with a once-in-a-century pandemic and an economic crisis more severe than the Great Recession, the next Administration will have even less time to devote to their legislative priorities. That’s why a 110 page pdf, packed full of wonky paragraphs and policy proposals, devoid of a single chart or picture, may be one of the most exciting documents in politics right now.

The Biden Campaign’s Unity Task Force Recommendations have a title like a new Avengers movie, if the Avengers were real policy nerds. They’re the product of six task forces, made up of some of the top progressive and centrist policy advisers.

There’s no Medicare-for-All, but there is a no-deductible, no-copay public option that would be available to everyone across the country. People with low incomes who weren’t eligible for Medicaid in their states would be automatically enrolled in this plan (and could unenroll at any time if they preferred). The Task Force also recommends lowering the eligibility age for Medicare to 60, restricting how fast drug prices could rise and capping them entirely for seniors and making sure that all private health plans cover mental health care and Medicare fully covers dental, vision and hearing benefits.

It sounds wonky, and perhaps not as easy to message as a straightforward Medicare-for-All plan, but these ideas would make a huge difference. They’d mean that a 60 year-old stuck to his job for the health insurance could finally retire early or try a new job (and thereby open up more positions for younger workers). They’d finally slow the rampant acceleration of drug prices, which has some echoes here in Virginia where state law now says that no Virginian will have to pay more than $50 a month for insulin.

These kinds of regulations are critical for people who have chronic conditions and need to have a predictable, stable way to figure out their monthly budgets. And imagine the relief of being on private health insurance and not having to worry about whether your therapy will be covered, or being on Medicare and not having to find a supplemental plan just so you can afford a hearing aid.

The real solid core of hope in this document comes from two things – priorities and process.

The Task Force starts its health care section by talking exclusively about responding to the COVID-19 pandemic, recovering and rebuilding our public health infrastructure. This is crucial. This year has proven that global health threats are not just a concern for health care professionals. In a globalized economy, they need to be a central part of our national security.

But lastly, and crucially, while it might sound boring, the process of creating this document is actually the most hopeful part of it. Three years ago, the dramatic Republican failure to replace the ACA came from a relatively straightforward error – they never took the time to build the muscles of governing.

They were a party committed to repealing the ACA, led by a president who promised to cover everyone, without a prominent effort to reconcile the two. As of today, the Trump campaign still has not released a health care plan, but we do know that the Administration is asking the Supreme Court to strike down the entire Affordable Care Act while opening up ways for health insurance companies to offer plans outside of the consumer protections in the law and for states to reduce the number of people in their state enrolled in Medicaid. You can connect the dots through these actions and sketch the general picture of a strategy of deregulation and reducing the number of people on public insurance programs. But a sketch isn’t a strategy.

That is why this long, text heavy document is such a thrilling read. Because, as our nation wrestles with the greatest health threat in at least a generation, there are people working out details, understanding where to collaborate and where to compromise and learning how to work together to make American health care work better.

Brian Chiglinsky of Falls Church works in health care communications. A former director of speechwriting at the United States Department of Health and Human Services in the Obama Administration, he has worked in local, state, and federal government. Today he works for a health care company based in Bethesda, MD. His views are his own and do not represent those of any other organization.