We are having the wrong conversation on healthcare.
Instead of addressing the underlying problems driving unaffordability and access, we Democrats are spending all our time arguing over who is the most zealous in wanting to cover Americans. Over who has wanted to do so longer. Over who cares more about the health of Americans.
We talk about how we’re going to pay for it, but the reality is we’re already paying for it. We pay for it when we can’t switch jobs. We pay for it when new jobs are temp or gig jobs that don’t provide healthcare. We pay for it when all of our prices are higher. We pay for it when healthcare costs drive us into bankruptcy.
To be clear, I support the spirit of Medicare for All, and have since the first day of this campaign. I do believe that swiftly reformatting 18% of our economy and eliminating private insurance for millions of Americans is not a realistic strategy, so we need to provide a new way forward on healthcare for all Americans.
As Democrats, we all believe in healthcare as a human right. We all want to make sure there is universal affordable coverage. We know we have a broken healthcare system where Americans spend more money on healthcare to worse results. But, we are spending too much time fighting over the differences between Medicare for All, “Medicare for All Who Want It,” and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives.
We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.
That means controlling the cost of prescription drugs. That means investing in innovative technology to cut waste and boost access. That means changing the incentive structure for providers. That means shifting our focus on more stages of care. That means revamping what comprehensive care means in the 21st century to include crucial aspects of wellbeing. That means taking on the powerful lobbyists in D.C.
Diagnosing and addressing these underlying problems is the first and most important step in ensuring everyone has access to healthcare, because we cannot extend quality coverage to everyone without real strategies on how to avoid the toxic incentives of our current system. We can’t afford to mess this up.
Fundamentally, we need to have a more productive conversation about healthcare in America. It’s time to take a step back from enrollment mechanisms and creative accounting to focus on lowering costs and improving quality.
My full plan for a New Way Forward for Healthcare in America is a statement on the critical failings of our system and viable paths to solve them. We cannot find the answers to one of the most serious problems in modern American history unless we are asking the right questions. It’s time we start asking the right questions.
Problems to be Solved
- checkMillions of Americans live without healthcare.
- checkMany Americans who have healthcare have policies that don’t afford them the opportunity to receive proper care.
- checkDoctors are incentivized to act as factory workers, rather than doing what they’d prefer—spending extra time with each patient to ensure overall health.
- checkEven those with healthcare are often bankrupted by healthcare costs.
- checkHealthcare costs in this country are relatively high, and outcomes are relatively poor.
- checkHealthcare has become a political animal in Washington, and the grip of these special interests makes it almost impossible to draft and pass meaningful healthcare reform.
- Healthcare should be a basic right for all Americans. Right now, if you get sick you have two things to worry about – how to get better and how to pay for it. Too many Americans are making terrible, impossible choices between paying for healthcare and other needs. We need to provide high-quality healthcare to all Americans and a Medicare for All system is the most efficient way to accomplish that.
star star starMost everyone loves Medicare... A gradual phase-in would give the industry time to plan and adjust… There would inevitably remain a handful of private options for the super-affluent, but most everyone would use the generalized care.4/3/18 - The War on Normal Peoplestar star starWe need to get Healthcare off the backs of businesses and families and move towards a single-payer medicare-for-all system because [the current system] makes it harder to hire people [and] when you do hire people you want to make them contractors, not full-time employees.2/12/19 - Joe Rogan Experiencestar star starThe pitch we have to make to the American people is, we will get the health care weight off of your backs and then unleash the hopes and dreams of the American people.9/12/19 - Third Debate
- checkComprehensive healthcare for all Americans
- checkBend the cost curve of healthcare down
- checkAllow doctors and hospitals to innovate in treatment
- checkChange the incentive structure for doctors
- checkFocus on preventive care
- checkDiminish healthcare lobbying influences on Congress
As President I will...
- Control the cost of life-saving prescription drugs, through negotiating drug prices, using international reference pricing, forced licensing, public manufacturing facilities, and importation.
- Invest in technologies to finally make health services function efficiently and reduce waste by utilizing modernized services like telehealth and assistive technology, supported by measures such as multi-state licensing laws.
- Change the incentive structure by offering flexibility to providers, prioritizing patients over paperwork, and increasing the supply of practitioners.
- Shift our focus and educating ourselves in preventative care and end-of-life care options.
- Ensure crucial aspects of wellbeing, including mental health, care for people with disabilities, HIV/AIDs detection and treatment, reproductive health, maternal care, dental, and vision are addressed and integrated into comprehensive care for the 21st century.
- Diminish the influence of lobbyists and special interests in the healthcare industry that makes it nearly impossible to draft and pass meaningful healthcare reform.
An excerpt from The War On Normal People
As jobs disappear and temporary employment becomes more prevalent, reforming our health care system will be more and more crucial. Right now, most of us rely upon our employers to pay for and provide health insurance. This will be increasingly difficult to sustain as jobs with benefits become harder and harder to come by. On the consumer side, spiraling health care costs have already become a crushing burden for Americans. Health care bills were the number one cause of personal bankruptcy in 2013 and a study that year found that 56 million Americans – over 20% of the adult population - struggled with health care expenses they couldn’t afford to pay. We’ve all seen and heard the horror stories of people coming back from the hospital with a bill for tens of thousands of dollars. For many Americans it’s a double whammy if you get sick – you not only have to deal with the illness or injury but you have to figure out how to pay for treatment.
In general, the use of technology has not transformed health care the way that optimists would hope. Health care costs have continued to climb to a record 17.8% of the economy in 2016, up from 11.4% in 1989 and less than 6% in 1960. We spend about twice what other industrialized countries do on health care per capita to lesser results. According to a 2014 Commonwealth Fund report, we are last among major industrialized nations in efficiency, equity and health outcomes attributable to medical care despite spending much more than anyone else. Another study had the U.S. last among developed countries in basic measurements like the rate of women dying due to pregnancy or childbirth and rate of survival to age 5. To the extent that new technology is used, it tends to be expensive new devices and implants that drive costs ever higher. The basic practice of medicine, as well as the training, is the same as it’s been for decades.
Our job-based health insurance system does the very thing we most want to avoid – it discourages businesses from hiring. For employers, company-subsidized health insurance costs are a major impediment to hiring and growth. The costs get very high for senior people with families - my last company was spending more than $2,500 a month on certain people’s insurance plans. If these costs weren’t on our books we definitely would have hired more people. Health insurance also pushes companies to make as many employees as possible into part-time gig workers or contractors.
On the worker side, tons of people hang on to jobs that they do not want to be in just for the health insurance. Economists refer to this as “job lock;” it makes the labor market much less dynamic, which is bad in particular for young workers.
As jobs disappear, having one’s health care linked to employment will become increasingly untenable. The need for a different approach is growing.
Health care is not truly subject to market dynamics for a host of reasons. In a normal marketplace, companies compete for your business by presenting different value propositions and you make an informed choice. With health care, you typically only have a few options. You have no idea what the real differences are between different providers and doctors. Costs are high and extremely unpredictable, making it hard to budget for them. The complexity leaves many Americans overwhelmed and highly suggestible to experts or institutions. When you actually do get sick or injured, you become cost-insensitive trying to get well. Hospitals often employ opaque pricing, resulting in patient uncertainty over what their insurance will actually cover. Moreover, when you’re ill, it’s possible your faculties can be impaired because of illness, emotional distress or even unconsciousness.
As Steven Brill wrote in his seminal Time magazine article on health care costs, “Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot.” The lack of real market discipline or cost control incentives has driven costs ever higher. Technology that should decrease costs has been kept at the door because for most actors in the system, the goal is to increase revenue and profitability. The more services, tests, appointments, procedures and expensive gadgets you use, the better. The system rewards activity and output over health improvements and outcomes.
Changing these incentives is key.