David Nather Jun 16, 2018
Forget the Affordable Care Act: The future of our health care
system will be shaped by a much bigger and broader fight — one that will likely
culminate with a 2020 choice between private markets and an authentic
government-run program in the form of a Bernie Sanders-style Medicare for
All.
The bottom line: The cost
of health care — both for individuals seeking coverage and the government
seeking sustainability — promises to return as the biggest domestic issue once
the Trump obsession burns off.
This is one of America's great unsolved problems: We have the
world's best care, talent and innovation. But before it gets to patients, the
magic goes through a hodgepodge of inexplicable, expensive and unnecessary
hurdles.
What's next: The health care debate is
no longer a linear fight over a straight repeal of President Obama's health
care law. Instead, it has metastasized into a multi-front war.
One of our most vital national systems is falling apart:
- Medicare is running out
of money faster than expected — a reminder that
no one's dealing with that problem, and that there's no way to duck it in
2020.
- The opioids crisis
continues, with Congress trying to pass a ton
of mini-bills to look like it's doing something. A few of them might make
a difference. This remains a
crisis — and a costly
one.
- And don't forget prices. The
U.S. doesn’t use more health care than other countries —
we just pay more for it. Consumers are
getting sick of it, and eventually they’ll respond to politicians with
plans that seek to bring down prices (as they already have on prescription
drugs).
- Polls show health care
is at the top of the list of voters' concerns for
the midterms. So look for it to dominate the early rounds of 2020.
The new battlegrounds, as
sketched by Axios managing editor David Nather:
- The ACA repeal fight has
moved to the courts, and the Trump administration has
picked a fight over preexisting conditions — one of the most popular parts
of the law.
- But Republicans haven't
given up on repeal. A group of outside conservatives is
about to unveil a new planand push congressional Republicans to take one
more vote before November's midterms — even though there's no sign that
any votes have changed.
- "There's going
to be at least one more grassroots effort to convince them to
take another run at health care" so base voters don't think
Republicans have given up, said Lanhee Chen of
Stanford, a former Mitt Romney adviser who's part of the group.
- Democrats have moved on
to Medicare for All. The
fight to watch will be between establishment Democrats, who want to make
it voluntary and preserve a role for employment-based private insurance,
and Democrats from the Sanders wing who are ready to move everyone into a
government-run system.
- "Democrats have
always felt that health care should be a right," and
they've watched the ACA actually become more popular under attack,
said Neera Tanden,
a former Hillary Clinton adviser who heads the Center for American
Progress.
- ACA premiums are going
up, and for the first time it's Democrats
who will try to turn that into a campaign weapon.
- But health care spending and
premiums are rising for everyone else, too.
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