What we mean by ‘health care unity’

A new plan for pragmatic and progressive health care reform

David Bowen is a Senior Fellow at the Searchlight Institute, where he provides advice and policy recommendations on health care policy.

When Congress enacted the Affordable Care Act, I served as the health policy director for the Senate Committee on Health, Education, Labor and Pensions under the chairmanship of Senator Ted Kennedy of Massachusetts. That meant I played a critical role in developing and writing the ACA — one of the most transformational and progressive health care reforms in American history.

Over recent months, we at Searchlight have released a health care agenda that would reshape our health care system once more. The proposals will lower health care costs, make health care more available for Americans, and help rebalance power away from corporate interests and towards patients.

We call this the Health Care Unity Agenda. It’s a plan that can appeal equally to those who want to make significant and much-needed changes to our health system and to those who want to work within the framework of the current system to provide more, not fewer, good health choices for Americans.

Pragmatic idealism

Before I dive into what this plan actually is, I want to take us back to the last time we made sweeping health care policy changes in this country. Many of the debates we’re having today have their roots in that moment, including the debate over Medicare for All.

When I worked for Senator Kennedy, I wrote a Medicare for All bill — but it did not have a single co-sponsor when it was introduced and had no pathway to enactment.

While the Medicare for All idea has gained more support since then, it would still require a massive restructuring and multi-trillion-dollar refinancing of the health system. Public support for such a profound change appears to be ambiguous at best. Searchlight polling has found that although Americans are open to a much larger government role in our health care system, they have doubts about government’s ability to administer it successfully, and most do not want to make the changes in their health plans that would be required under a single-payer system.

The idea that health care should be a right and not a privilege was a guiding passion of Senator Kennedy’s life. While his goals were idealistic, his approach to reaching those goals was utterly pragmatic. He wanted to use each bill and each session of Congress to make as much progress as possible — then build from that point to make more progress in the next session.

Senator Kennedy had been part of several unsuccessful efforts to enact health reform from the 1970s to the 1990s and had no wish to be part of another noble failure in 2009. That’s why, instead of making a futile attempt to pass a bill that had no pathway to success, he emphatically chose to move forward with the most progressive health care reform that could pass Congress and be signed into law.

That bill was the ACA, with all the compromises it entailed.

Pragmatic legislating can disappoint idealists, but as a result of that pragmatism, millions of Americans have been protected from discrimination based on pre-existing conditions and have received better health care. None of those progressive improvements in our health care system would have been possible had Congress tried and failed to pass a more expansive bill. Even then, the ACA barely squeaked through the legislative process without a single vote to spare when it passed on that snowy Christmas Eve.

Moving forward with the most progressive bill that could actually pass was the right choice for the ACA, and I believe it is the right choice now.

The Health Care Unity Agenda

Our plan provides millions of Americans with new coverage, makes basic primary care free for every American, reduces the cost of prescription drugs and medical care, and reins in the power of monopolies and private equity to dictate terms to patients. It includes a robust public option to keep costs down and gives Americans a voluntary alternative to for-profit health insurance.

You can read the full report here. But this is a brief overview of the practical changes we are proposing.

The ACA required private insurance to make preventive care cost-free. We expand that provision to include basic primary care. This means a patient’s usual first point of contact with the health care system, which focuses on treating common illnesses or physicals, will now be available for patients at zero out-of-pocket cost.

The ACA allowed kids to stay on their parents’ plan until they were young adults. We expand that idea to include family members and loved ones, giving more people access to coverage.

To rein in costs, we build on existing proposals like negotiated drug prices, but add in new ideas, such as allowing the federal government to open up more competition when the prices of some drugs are too high. We end the games that companies play with patents to jack up prices for consumers, and establish a new $2,000 out-of-pocket threshold for drug costs, modeled on Medicare.

To make health care work better for patients, we crack down on “rationing by inconvenience,” where insurance companies set up rules to deny care and frustrate patients. We also set up new safeguards to prevent private equity firms from looting the medical clinics local communities rely on, demonstrably worsening outcomes for patients. Our plan establishes new thresholds for oversight, a new license to engage in health-related private equity transactions, and tough new penalties for interference in medical decisions.

Building on the starter home

President Obama called the ACA a “starter home.” And it was a pretty solid one. While I’ve seen the ACA derided from the left and the right, it is a signature progressive accomplishment of this century. It made a tangible difference in millions of people’s lives. Today, it serves as a model for how we can improve our health care system in a way that is pragmatic and supported by the public.

Again, I want to emphasize the word unity.

The ACA passed because a working majority in Congress, through much debate and inspired leadership, came together around a unified plan for how to reform our health care system. To achieve that unity, Members were prepared to put the broader goal of reform above achieving some of their own personal priorities. That same unity and flexibility will be necessary to enact the health reforms that are needed to make health care truly serve patients at costs they can afford.

To improve lives, we don’t need to tear down the ACA “starter home” and build a new one. Our proposals offer a new set of blueprints for renovating it in a way that is pragmatic and responsive to what Americans want out of their health care system. They offer a way, once again, to create the most progressive bill that can pass a future Congress and be signed into law.