Health Care in America

As we slouch towards the Bethlehem that is the 2024 Presidential election, the distractions around us are increasing. Every day there appears to be someone reciting new poll numbers about the candidates. Every day there appears to be a new revelation, a disturbing allegation, or an incredible accusation regarding one candidate or another. This is happening not only in the Presidential election but also in the state elections for Congressional members, for governors, for representatives to State Houses, etc. As voters, we can easily find ourselves in an electoral funhouse of mirrors, smoke, and noise.

I’ve been spending some time looking at the issues in this election, and where each of the two major political parties stands on those issues. This past weekend—after the GOP Presidential candidate said that, if he is elected, women would become “healthy, happy, confident, and free”, I thought I would look at health care.

It think it’s important to understand that a political party’s platform outlines that party’s intentions. It does not act as a guarantee of a future reality. A party’s intentions must be turned into programs and agencies and laws, and that involves the participation of the House of Representatives and the Senate. Hence, those two bodies—not the candidates, their election committees, or their advisors—ultimately bring about or defeat what the party platform proposes.

The Inflation Reduction Act—introduced by the current President and passed by Congress—has a lot to do with our present healthcare system. Its biggest achievement, as you probably already know, was to empower Medicare to negotiate prices with Big Pharma for the first time in history. What this meant was billions of dollars of savings to Medicare. In 2025 it will also mean an annual cap on out-of-pocket medication expenses for seniors. If you’re not a senior citizen, of course, this will not affect you. If you are a senior citizen taking medications, it will.

In examining what the GOP platform proposes to do in the area of health care, it’s important to know that at the top of the list is actually to repeal the Inflation Reduction Act. As a result, big pharmaceutical companies would once again charge senior citizens whatever they wish. There would be no 2025 cap on what seniors would have to pay.

The GOP platform calls for the weakening of Medicaid, the free or low-cost public health insurance program for low-income adults, pregnant women, children, older adults, and people with disabilities. As of March 2024, more than 82 million people were enrolled in Medicaid. The GOP platform calls for lifetime caps on benefits. It also asks for a work requirement for individuals seeking coverage through Medicaid. That last sounds reasonable…until you consider children, pregnant women, elderly people, and people with severe disabilities.

The GOP platform proposes the elimination of no-cost coverage for contraception. It eliminates insurance coverage for emergency contraception while it suggests coverage of “natural family planning methods” (although these natural planning methods are not defined). It allows employers providing health insurance to deny coverage for contraception. Additionally, it proposes preventing public health agencies from requiring the vaccination of school children.

Regarding women’s reproductive rights, the GOP platform proposes the establishment of a method of collecting data regarding abortion. This data will give the government information on: how many abortions are performed in each state; at what gestational point an abortion is performed; for what reasons the abortion is performed; by what method the abortion is performed; the mother’s residence by state. The platform, unfortunately, gives no reason why the federal government would need this information.

Oddly, also part of the GOP health plan is to invalidate state laws stemming gun violence.

The Democratic platform proposes to build upon the existing Affordable Care Act (also called Obamacare). Through the Affordable Care Act, the platform wishes to allow people the choice of an affordable public option that would be available through the Affordable Care Act marketplace. One of the public options would have no deductible and all options would control costs by negotiating treatment prices with doctors and hospitals, as Medicare does now. Everyone would be eligible.

This platform proposes to expand the National Health Service Corps and the Teaching Health Center Graduate Education Program in order to expand the number of available health care workers, including primary care nurses, dental professionals, and mental health and substance abuse counselors. It proposes empowering Medicare to negotiate drug prices for all public and private purchasers. It would make out of pocket drug costs for chronic health conditions available at little cost or no cost. It would expand Medicare to include dental, vision, and hearing care.

The platform proposes to ensure that health insurers adequately cover mental health and substance abuse treatment. Publicly supported health clinics would be required to offer medication-assisted treatment for opioid addiction and other substance abuse disorders.

The platform proposes—based on statistical research—to level the playing field with regard to the insured and the uninsured. Prior to the pandemic, the uninsured rate was three times higher for Latinos and twice as high for Black Americans than it was for white Americans. One in five Native Americans was uninsured. The Democrats propose to launch a sustained, government-wide effort to eliminate racial, ethnic, gender, and geographic gaps in insurance rates and in access to quality health care.

Perhaps the largest difference between the two parties’ platforms exists in what they each propose to do about reproductive care. I’ve already listed the items I found in the GOP platform. The Democrats’ platform proposes to restore federal funding for Planned Parenthood in order to provide preventive and reproductive health care, especially to low-income people, people of color, and members of the LGBTQ+ community. Additionally, the platform proposes an expansion of postpartum Medicaid coverage for a year after the birth of a child as well as an investment in rural maternal health. There are proposals for investments in community health centers, rural health clinics, underserved urban and rural areas, paying health workers a minimum of $15/hour, and advanced funding for cancer research. It is, indeed, a large plan and a hefty wish list. And like all proposals and wish lists, not everything on it would make the cut. But what I find interesting about it is that it wants to add to what we have. The GOP platform wants to take from or eliminate altogether what we have. For me, that’s a telling difference.

To conclude, I’d like to share a very brief story that I was told by one of my friends a few years ago. She was in the habit of walking in the morning with one of her neighbors and, on one of these walks, her neighbor said the following to her: “I happen to believe that not everyone deserves health care.” To use a British term, I was gobsmacked when I heard this. I wondered who, in her mind, actually deserves health care? Is it only white people living in expensive houses in gated communities that deserve health care? Is it only college-educated people? Is it only those who belong to a particular political party? What about babies with birth defects? Do they deserve it? What about children with leukemia? What about pregnant women with no access to local clinics? How about the victim of a farm accident—like the young boy who lost both arms in a piece of machinery? Should he have “been more careful”? What about the young man who cut off his own arm to escape being trapped while hiking? Was he just stupid to have gone hiking alone? And in the end, who decides upon the deserving candidates for health care? A government agency staffed by political appointees? Is the truth that health care a human right? Or it is merely a human privilege?

We have a big decision looming in front of us and a lot of noise getting in the way of our making an informed choice. This, I think, is a huge decision, one that will be life-changing for many people. It involves more than betting on which candidate is going to lower gas prices, the price of eggs, interest rates, or the general cost of living. No candidate has the power to do any of that. Instead it involves deciding upon which candidate offers proposals to move the country forward in a way that all people benefit in some manner, not just a singular group.

Elizabeth George
September 24, 2024
Seattle, Washington