The debates over how we pay for health care threaten to eclipse any other health-related topic in 2020. The Affordable Care Act (ACA) is again under threat from a lawsuit working its way through the courts. Democratic presidential candidates are debating financing schemes ranging from immediate and full public takeover of health insurance to more stepwise public-private arrangements. And our governor’s newly released “state option” will add some local gasoline to this national fire.
Those of us advocating for investments in public health prevention or addressing SDOH won’t be able to shout over the din. But the polarization surrounding health reform may be creating an advocacy opening. There seem to be many moderate-progressive politicians who dread questions about whether they support Medicare for all. On its face, it is popular with Democrats, but loses support when details are discussed, according to recent research from the Kaiser Family Foundation. On the other side, there are probably some conservative politicians who hesitate to provide a direct answer on axing the ACA, something that pleases their extreme base but could end up harming many of their constituents.
Can we position public health investment as a more politically neutral, “common sense” option for the wary legislator or candidate?
When asked “do you support Medicare for all?”, a progressive politician could answer: “While it’s important to address how we pay for health care, I think we need to refocus our attention on the high rates of preventable illness that are driving most of these costs. The best way to save people money on health care is make it less likely that they become sick in the first place. Investing in public health prevention is how we do that.”
A conservative politician asked whether they support repealing Obamacare could say the exact same thing. It seems like a dodge, but our national political obsession with how we finance health care has distracted the public, policymakers, and even policy wonks from the causes behind why we pay so much, and this needs to change. By invoking the thrifty, common sense, and evidence-based reasons for investing in prevention, politicians can claim a sensible middle-ground.
I think this approach could also appeal to many in the “exhausted majority” who are watching the extremes of each party with increasing alarm, disgust, or apathy. These are people who understand all too well that having coverage does not mean you won’t be bankrupted by medical bills, who scoff at an 18% reduction on a premium they couldn’t come close to affording anyway, and who are wondering just how many PhDs one might need to understand why a health care system is harming them so much. These are also people whose participation and leadership we need on a local level to create an effective and equitable public health system.
The upcoming holiday season is a perfect opportunity to test this on your family and friends. If you find yourself at a politically polarized table with a health reform debate threatening to ruin the evening, give the common-sense prevention argument a try.