With each new round of Democratic presidential debates, the faint outline of a single-payer health care system gains shape. The substance of Medicare for All is dubious at best, yet it gains steam because it casts a compelling vision.
By contrast, although President Donald Trump has made incremental moves to help patients receive better and cheaper care, his substantive accomplishments have lacked a compelling vision. By recasting his health care message as a bold economic vision, Trump can defeat both Democrats and Medicare for All at the ballot box.
Under the constraints of a gridlocked Congress, Trump has taken helpful steps to lower patient costs and increase care quality — including an executive order mandating price transparency and expanding health savings accounts to cover direct primary care expenses. These moves build on his administration’s expansion of short-term/limited-duration insurance, among other actions.
This incremental approach is the most viable option at the moment. But it leaves Trump with no central message on how to reform health care.
With the 2020 election just around the corner, Democrats are exploiting this weakness. Juan Williams explained the problem on Fox News: “There’s no (Republican health care) plan after talk of repeal and replace of Obamacare. Two years of Republicans controlling the House and the Senate and the White House … nothing!”
Democrats are filling the message vacuum with Medicare for All. In Medicare for All, the Democrats have the opposite of Trump: all vision but no substance. Despite the overwhelming evidence that a single-payer system will fail, Medicare for All remains popular because it brilliantly messaged in three words.
A well-messaged vision is powerful. Obamacare’s vision propelled its namesake into the White House. The promise to repeal it helped Trump win the greatest electoral upset in our nation’s history. So, Medicare for All will undoubtedly sway the 2020 election one way or another.
But being against Medicare for All isn’t enough. Without an attractive, competitive alternative, Trump could lose in 2020 despite great economic success and significant progress on other issues.
The first step to an effective vision for health care reform is not allowing Obamacare to define the issue. That mistake led to a polarizing reform approach that failed in 2017. Obamacare is popular because of its protection for pre-existing conditions and coverage of young adults up to age 26.
The Kaiser Family Foundation’s monthly survey in June showed that 46 percent of Americans view Obamacare favorably. When you define a health care reform plan in opposition to Obamacare, you immediately alienate almost half of the electorate.
Obamacare did not single-handedly destroy our health care system. In Catastrophic Care, David Goldhill correctly states there was nothing truly new about Obamacare. It was merely the next step in the decades-old process of making health care more regulated, more expensive and less efficient.
We need to move beyond Obamacare, not fall back into the failing system that spawned it.
A more effective health care vision would leverage Trump’s business background, replacing the political approach to reform with an economic, Obamacare-agnostic approach: analyze every part of the health care system and eliminate or modify all inefficiencies.
All the administration’s executive orders and rule changes would organize nicely under that strategy. Under an economic vision, it makes sense to scrutinize pharmacy benefit managers, group purchasing organizations, and even health insurance itself — when it is used to finance routine care.
This economic narrative also competes with Medicare for All. An economic vision avoids the trench warfare that would inevitably result from another political battle defined by Obamacare. It also affords Trump the opportunity to offer an olive branch to the 46 percent of Americans who like Obamacare. A statesmanlike, nonpartisan appeal can win over independents and moderate Democrats, defeating Medicare for All.
The window of opportunity is still open for Trump to offer this vision that combines substance and sizzle. But, with each Democratic debate showing more enthusiasm for Medicare for All and less time until Election Day, the window won’t remain open for long.
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