The 2018 midterms may have left behind more questions than answers. Not only does partisanship remain high, there are deep rifts within the two major parties themselves—particularly when it comes to healthcare.
At an event sponsored by Health Affairs on Friday, two policy experts from opposite sides of the political spectrum shared the stage to discuss how their parties could approach healthcare in 2020.
New York University’s Sherry Glied, who participated on President Bill Clinton's Health Care Task Force and served at the Department of Health and Human Services under the Obama administration, said “Medicare-for-All” can solve a lot of what ails the healthcare system.
“If your first priority is to reduce profits, eliminate fragmentation, improve transparency, make the system sensible, democratically responsive, reduce overall costs, all those good things, you want to go for a single-payer approach,” Glied said.
“But the benefits of this plan...are also its greatest weakness,” she continued. For instance, price transparency would improve tremendously, but what are now “invisible” costs, such as employer cost-sharing, would become immediately apparent to voters.
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Democrats could also rally behind a model where individuals and employers can choose between public and private plans—similar to traditional Medicare and Medicare Advantage. But as we’ve seen in Medicare Advantage, this would be difficult to run and contain many of the same issues in the existing private market.
Another option is creating a Medicare buy-in for the costliest population groups, including residents of areas that lack plan competition, which Glied described as “weak tea," or extending the use of public prices, which would require getting the prices right.
“In 2020, Democratic candidates are going to be thinking about solving a set of specific problems while incorporating some version of something called a ‘public plan,’” Glied said. Regardless of how Democrats design their platform, potential candidates must start thinking now about what they hope to achieve, she said.
Stanford’s Lanhee Chen, who has advised candidates from Marco Rubio to Mitt Romney to George W. Bush, also advised his party to think through their message.
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While Democrats have a number of options on the table, Republicans have to come up with a message to begin with.
“One of the things that the 2018 campaign exposed is the danger of not having a great answer on health reform and how to move forward,” Chen said.
And like Democrats, Republicans face division within their party, especially around the Medicaid expansion, Chen said. While moderate Republicans have come to embrace the expansion, conservatives remain staunchly opposed to it. Voters, even in three red states, backed Medicaid expansion on the ballot, proving that it could be a tricky issue for Republicans to navigate.
But Republicans can unite around the principle of federalism, Chen said. President Trump, who will likely be the GOP’s nominee in 2020, and his administration have favored this approach by giving states flexibility to innovate reforms.
Chen recommended Republicans unite around the state innovation approach and campaign on their successes with it.
Glied and Chen both articulated their thoughts in the most recent edition of Health Affairs.