Right now, we have no choice but to wait for votes to be counted and 2020’s election results to become final. Those tallies will eventually tell us who will not only occupy the Oval Office but also control the United States Congress. While we wait, it’s worth diving into potential changes to our health care system. After all, many voters identified health care as one of their primary concerns when heading to the voting booths.
In the final presidential debate, former Vice President Joe Biden said that he would not only work to preserve the Affordable Care Act, aka “Obamacare”, but to expand it, in what he referred to as “Bidencare”. As I understand it, there are three primary foci of such an expansion.
First, and most ambitiously, would be a “public option” for those who feel they are not well-served by their current insurer. From Biden’s website this would be a “public health insurance option like Medicare”, so presumably not identical to Medicare, but similar. One can see the influence of former South Bend Mayor Pete Buttigieg here. Mayor Pete was a consistent advocate of a public option when he was campaigning for the Democratic presidential nomination, in contrast to the calls for “Medicare for All” by the likes of Senator Bernie Sanders. Buttigieg has since become a close advisor to the Biden/Harris campaign.
The second and third areas of expansion are less ambitious, but still potentially impactful. One would increase “tax credits to lower premiums and (thereby) extend coverage”, and the other would be to offer “premium-free access to the public option” for those living in the 14 states who would otherwise be eligible for Medicaid expansion under the ACA, but whose states have chosen not to expand such Medicaid eligibility.
Opponents to Bidencare, mostly Republican, will continue to lambast Biden’s plans as “socialized medicine” and the “government takeover of our healthcare system”. But the truth is, much of our current healthcare system has already been taken over by government and is therefore socialized. In 2019, our total spending on healthcare was $3.6 trillion, of which $1.7 trillion was subsidized, directly or indirectly, by government.
Biden’s proposal to expand Obamacare as Bidencare, rather than make radical changes, reflects Biden’s political history. It’s an incremental, not a radical, approach. Generally, I think incremental change is a good thing, but in this case, it is incremental change going in the wrong direction. While Obamacare had a few good elements and has become fairly popular with the public, its fundamental flaw was that it mostly just expanded an already seriously defective healthcare system, while largely protecting the healthcare industrial complex. Biden’s plan, if realized, will do more of the same.
On the other side of the political aisle, if Republicans, led by either President Donald Trump or Senator Mitch McConnell, are serious about delivering results, they will have to do better than they did in 2017 and 2018 when Republicans controlled the White House and the entirety of Congress. Despite many running on pledges to “Repeal and Replace”, no serious legislation was considered to either repeal or replace the ACA. The most the Republican-led Congress could manage was to eliminate the penalty for violating the individual mandate portion of the ACA, which required that everyone have healthcare insurance or pay a fine. Depending on the final outcomes of the election, Republicans will have a say in the health care debate and they must have a plan.
As a physician for over 30 years, I can tell you without hesitation or equivocation that our healthcare system is in dire need of real reform. Our status quo has failed us, and will continue to do so. Obamacare was largely an extension of that status quo and so would be Bidencare. I’m not a fan of Medicare for All, either. I think we can find a better way, an American way, that values ideals such as transparency, competition, and fairness. I believe we can create a more vibrant healthcare system; one which delivers better results, is much less costly, and ensures that no American is left behind.
We may yet have to wait a couple of election cycles to begin to realize such a dream, but in the meantime, I look forward to sharing my thoughts with you going forward.
Dr. Chris Peters is a Contributing Scholar to TEF Iowa, a 9-year Army Medical Corps veteran, a surgeon, and a small business-owner in Coralville. He was also the Republican candidate for U.S. Congress in Iowa’s 2nd District in 2016 and 2018. Most importantly, Chris has been happily married to Julie for 26 years, is the proud father of three adult sons, Cole, Jake, and Caleb, and is the delighted grandfather to Jake’s son, Liam.