“I’m having déjà vu all over again.”
New Jersey Sen. Cory Booker said it best when quoting Yogi Berra at the fourth Democratic presidential primary debate Tuesday night in Ohio, where candidates found themselves having the same debate, answering the same questions, and reiterating the same talking points about health care, gun violence, and higher education.
While they get the overall problems in these areas right — health care is unaffordable and higher education is out of reach for many — the solutions offered up are often grand, sweeping, and lacking in details. Instead of talking about ideas that — whatever their merit — will likely never become legislation, candidates could better spend their time on stage discussing concrete, achievable policy solutions that are likely to pass through Congress and have an immediate impact on Americans.
The Health Care Affordability Problem
Before launching into a pitch for her Medicare for All plan, Massachusetts Sen. Elizabeth Warren summed up the problem with health care today: It’s simply unaffordable. “I spent most of my time studying one basic question, and that is why hardworking people go broke. And one of the principal reasons for that is the cost of health care. And back when I was studying it, two out of every three families that ended up in bankruptcy after a serious medical problem had health insurance. The problem we've got right now is the overall cost of health care,” she said.
In nearly every debate, the discussion about how to bring down those overall health care costs has been dominated by just one idea: Medicare for All (or Medicare for All Who Want It). But there are other, more immediately attainable policy solutions to the affordability problem, and some of them are already working their way through Congress.
One of the reasons Americans go broke paying for health care is surprise out-of-network bills. They have become so commonplace that NPR and Kaiser Health News built a series on them featuring one outrageous story after the next. It’s an issue worthy of the candidates’ attention.
Surprise bills often come in emergency care, but even planned procedures can result in unexpected charges. And according to a study examining data from a large national insurer, out-of-network emergency physicians charged on average about eight times what Medicare pays for the same services.
In Washington, legislators have been working on a bipartisan, bicameral policy that would require insurers to pay providers a locally based market benchmark in certain out-of-network situations. However, a last-minute amendment added arbitration to the bill, which will shift costs for consumers from surprise bills to higher insurance premiums, according to the Congressional Budget Office, and undermine Congress’ efforts to fix this problem.
Democratic candidates should push for removal of this arbitration amendment, which is supported by private equity firms and physician groups, and support policy solutions that will provide real, immediate relief for families.
The high cost of prescription drugs is also a major contributor to the health care affordability problem. While trying to steer the conversation away from Medicare for All, Minnesota Sen. Amy Klobuchar said, “We can take on the pharmaceutical companies and bring down the prices.”
Vermont Sen. Bernie Sanders also drove the point home: “I will tell you what the issue is here. The issue is whether the Democratic Party has the guts to stand up to the health care industry, which made $100 billion in profit, whether we have the guts to stand up to the corrupt, price-fixing pharmaceutical industry, which is charging us the highest prices in the world for prescription drugs.”
The drug pricing system in the U.S. is broken — prices are double that of 19 peer nations. Blame a lack of competition, government monopolies that grant too much power to manufacturers, and special interests intent on blocking reform. More than 80 percent of voters think prices for prescription drugs are unreasonable, and a majority want politicians to fix this problem.
While there’s no silver bullet, federal lawmakers have introduced more than 60 pieces of legislation this year on drug pricing. Candidates should be discussing bills like the CREATES Act, which will help end patent abuses and anticompetitive behaviors that keep cheaper generic versions of drugs off the market, driving up costs for patients, employers, and taxpayers.
At the state level, California Gov. Gavin Newsom just last week signed into law a ban on “pay-for-delay” tactics that allow pharmaceutical companies to block development of cheaper generics, leaving Americans struggling to afford the medications they need to survive.
And Louisiana now serves as a model for other states, thanks to its breakthrough approach to providing affordable hepatitis C treatments to the state’s Medicaid and corrections populations.
These are all policy solutions to the affordability problem that don’t fall along partisan lines and have the potential to make it through Congress.
The Public Health Crisis of Gun Violence
“I just keep thinking of how close we are to finally getting something done on this,” Klobuchar said during Tuesday night’s discussion of gun violence, and she is right.
Since the tragic mass shootings in El Paso and Odessa, we’re seeing serious Congressional efforts to address this problem, but as Warren pointed out, it’s not just about mass shootings — more than two-thirds of gun-related deaths in the U.S. are due to suicide.
“It’s what happens in neighborhoods all across this country. It is about suicide, and it is about domestic violence,” Warren said. She added: “I want to get what works done.”
One problem is that we don’t know enough about what works. While many policies aimed at reducing gun violence perform well in public polling, lawmakers lack the robust, objective research necessary to know which policies will be the most effective at saving lives. For nearly two decades, Congress has refused to properly fund research into gun violence policies.
It looks like that is about to change. The House of Representatives has successfully passed a $50 million appropriation for the National Institutes of Health and the Centers for Disease Control and Prevention to study firearms. And Sen. Johnny Isakson (R-Ga.) recently introduced a bill to fund research — $75 million per year for five years — at the CDC.
Candidates could devote more time in the debate to supporting the federally funded research that is necessary to answer crucial questions about gun violence and guide meaningful reforms. Philanthropy has stepped in, but it can’t replace the long-term support that only the federal government can provide.
Improving Higher Education Outcomes
Higher education tended to get lumped into larger discussions of jobs and income inequality, but when it was mentioned, the focus was on free public college and the elimination of student debt.
“When we talk about making public colleges and universities tuition free and canceling student debt, we're going to give those people the opportunity to get those good jobs,” said Sanders in response to a question on whether he was promising jobs for every American hit by automation.
While affordability is a real issue in higher education, so is accountability. Taxpayers and students are making a significant investment of resources and time in higher education, and they need to know they are getting a return on that investment. Right now, there are several concrete proposals on the table to address higher education issues that these presidential candidates could be weighing in on.
For one, they could call on Congress to collaborate on a bold, bipartisan bill that improves student outcomes and holds institutions accountable. The package of bills recently introduced by Sen. Lamar Alexander (R-Tenn.) doesn’t go far enough: It should include investments in evidence-based programs that are proven to work, as well as provisions to protect students from low-quality or predatory schools and introduce transparency into the system.
Right now, students don’t have access to meaningful data when making decisions about which school to attend — has the campus graduated students with similar backgrounds, and what do graduates typically earn? (The bipartisan College Transparency Act, which Alexander signed as a co-sponsor, does address these questions.) Alexander’s bill also allows Pell Grant dollars to be directed to short-term programs that don’t have a proven track record, and history tells us this will open the door for predatory institutions to take advantage of students.
A new bill by Rep. Bobby Scott (D-VA) to reauthorize the Higher Education Act does better: It includes critical reforms on data and accountability, blocks predatory institutions from taking advantage of veterans and students, and will make information available on which programs are serving students well.
For most students, investing in higher education leads to better job opportunities and higher lifetime earnings. We need candidates to look beyond debt relief to the issues that are holding students back from reaching their full potential and, in some cases, leaving them with debt but no degree.