Government is the Solution, a Seismic Shift

Government is the Solution, a Seismic Shift

A major shift in thinking has occurred since the passage of the Affordable Care Act, aka Obamacare, and the political ramifications are likely to be enormous.

At his inaugural in 1981, Ronald Reagan said, “In this present crisis, government is not the solution to our problem; government is the problem.” This wrong belief has pervaded and controlled political thought for at least three decades and led to some very bad policies such as the bank deregulation that caused the financial crisis of 2008.

Recently, Republicans realized they have to actually develop a plan to replace the Affordable Care Act, and people are demanding that some important features are available in a replacement plan. These features include allowing people with pre-existing conditions to get insurance, no lifetime limits, and allowing children under 26 to stay on their parents’ plans.

It gets even worse for Republicans. People are also demanding improvements such as more affordable premiums and lower copayments and deductibles.

For the first time in many, many years, there is a popular uprising where people are saying to the government, “fix this.” People realize government is the solution.

This is not to say that the government is the solution for everything. However, the right government policies can provide great solutions to some problems as illustrated by health care.

In point of fact the public enables the private, and now that people are realizing this, it signifies a seismic shift in our politics.

The Economic Policy Disaster

There was something missing in the coverage of the most recent presidential campaign—policy. The major networks, ABC, CBS, and NBC devoted only 32 minutes of airtime to policy issues from the start of 2016 until late October according to the Tyndall Report:

No trade, no healthcare, no climate change, no drugs, no poverty, no guns, no infrastructure, no deficits. To the extent that these issues have been mentioned, it has been on the candidates’ terms, not on the networks’ initiative.

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Messaging Microcosm and Macrocosm

A recent vote in Montgomery County (MC), Maryland, illustrates the problem in microcosm that Democrats have with messaging.

This past November there was a proposal, Question B, on the ballot as to whether term limits should apply to County Council members and the county executive. A local Republican activist frustrated by the Democrats’ dominance on the Council pushed the proposal. In MC, 58 percent of the registered voters are Democrat, 19 percent are Republican and 22 percent are independent.

Clinton clobbered Trump by more than three to one in MC, 75 percent to 19 percent in the general election.

The local Democratic Party carefully researched Question B, and urged Democrats to vote against it. Their research was thorough and showed that when term limits were implemented, institutional knowledge was lost and that the influence of lobbyists and special interests increased.

So in a heavily Democratic area that defeated similar propositions twice before, Question B overwhelmingly passed with 70 percent voting for it and 30 percent voting against it.

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Strong Stances, Good Messages

According to Washington Post columnist E.J. Dionne Jr., “Pollster Allan Rivlin has been offering a compelling presentation to Democrats, arguing that they lack a clear, comprehensible and convincing economic message. He’s right. It’s time they got one.”

Let me second, third and fourth that. Democrats have not been getting their message out for a long time. This has caused the Democrats to lose big in the 2010 and 2014 midterms, and to lose the most recent presidential election in the Electoral College. In contrast, the unified messages provided by the Obama campaigns in 2008 and 2016 have contributed to his wins.

When I asked a Democratic supporter what do Democrats stand for, he had a hard time answering. When I asked dedicated Clinton supporters why they are voting for Hillary Clinton, they had to think about it. Even dedicated supporters had trouble stating their party’s or their candidate’s positions.

Before Democrats can frame their messages, the must stand for something. They can start by taking a bubble-up economic approach—adopting policies that help people on the bottom rung.

First they need to support Medicare-for-all so everybody has access to health care. While Obamacare was a good first step and has helped millions of people, it does not solve many of the problems in our health care system. Medicare-for-all would.

Second, we need to rebuild our crumbling infrastructure.

Third, we should provide free public education through college.

Fourth we should guarantee that everybody has adequate to food, clothing and shelter.

These strong stances would allow the Democrats to play offense instead of playing defense with Republican-lite policies that don’t work and move the country toward disastrous Republican solutions such as those implemented in Kansas.

These strong stances would provide Democrats with the “clear, comprehensible and convincing economic message” that is needed to show that they are committed to improving people’s lives and growing the economy. These policies would provide the strong stances necessary for good messaging and would allow Democrats to play offense for a welcome and necessary change.


Health Care and ‘Skin in the Game’

Other countries have implemented Medicare-for-all systems that do not require “skin in the game,” and they get better health outcomes at much lower costs. In fact, “skin in the game” causes consumers to forgo necessary health care. The most common way to implement “skin in the game” is with high-deductible health plans. As one health expert stated:

The nation continues to push forward with expanding deductibles in health plans in spite of evidence that they are creating great harm by increasing financial burdens on individuals and families and by impairing access to essential health care services and products.

Meanwhile, health insurance and pharmaceutical executives have no incentive to improve the system. For too long these executives have been able to act however they want without any consequences. This has literally killed people and caused bankruptcies—all in efforts for the companies to keep their profits high and for the CEOs to keep their salaries astronomical.

It is time to force these executives to have “skin in the game.” We need to define a series of performance goals for our health care system.

The first goal should be that our health system covers everybody.

The second goal should be to eliminate financial stress from accessing health care. Eliminating copayments and deductibles can achieve this.

The third goal is that patients should have the freedom to choose any medical professional or hospital.

The fourth and fifth goals should be to have the per capita health expenditure equal to or less than $4,750 and the health expenditure as a percentage of GDP that is equal to or less than 10 percent. According to data from the Organisation for Economic Co-operation and Development, which represents 35 countries, the average per capita health expenditure is about $4,750 for developed countries, and the average expenditure as a percentage of GDP is about 10 percent.

Until all goals are met, health insurance and pharmaceutical executives are limited to compensation that does not exceed ten times the minimum wage. Profits from the companies shall be used to reduce health care costs until the goals are met. Once met the companies may use their profits and compensate their executives however they want.

These executives have perpetuated a system that requires too many patients to sacrifice their good health, their financial well-being, and/or their lives. It is only fair that we make the executives have “skin in the game.”