The debate about crafting a health care policy that reaches all of its goals shows wide differences between the two parties. In 2010, the Affordable Care Act (ACA) was passed without one vote from the GOP in either the House of the Senate. In 2017, the GOP health care law that passed the House of Representatives but fell one vote short in the Senate similarly received no Democratic votes.
Why can’t the GOP and the Dems agree?
The reason for the lack of agreement has to do with the priority of the goals. Until we reach consensus, it is highly unlikely that a bipartisan bill will ever be passed. While there is general consensus on what the goals should be, it’s the priority that is the problem.
There are three goals of health care policy: cost, quality, and coverage. All will agree that health care should be priced as reasonably as possible, should provide for the highest-quality care, and should cover as many people as possible. But in what order should those goals be reached?
Ideally, we would like to reach all three goals. But when we put them in order of importance, we find that achieving a top-priority goal could result in the inability to fully reach another goal or two.
The GOP takes the traditional route.
The GOP would rank the quality of care as the highest goal. Republicans’ view is that it is of utmost importance that Americans receive the highest-quality health care possible. That means that Americans should have access to the latest medical advancements and to the most technologically superior equipment, without any delay.
Secondly, the GOP would rank cost. This high-quality care should be available at the most reasonable price to consumers. The GOP recognizes that by the nature of the health care market, with expensive research and approval costs coupled with inelastic demand, high costs are inevitable. But they believe that by applying more free-market policies that encourage competition, prices can be held down.
Thirdly, the GOP would like to see as many, if not all, Americans having access to this high-quality, reasonably priced care. For the most part, this ranking of goals has been followed traditionally: quality, cost, coverage.
Dems see things differently.
For Dems, every American should have access to health care. Indeed, they believe that health care is right and not a privilege. As such, they place coverage as their top goal. The ACA demonstrated that by “forcing” all Americans to buy health care coverage insurance, the goal of covering 100% of the population is achievable. They reasoned that this is the way every industrialized country operates: by placing coverage as the top priority.
Secondly, the Dems want the cost of health care to be affordable to all Americans, regardless of their ability to pay. As such, the ACA provided subsidies for low-income people who could purchase their insurance on government-created exchanges. By having government control much of the health care market, prices could be controlled to keep the cost to consumers low.
Thirdly, the Dems want high-quality coverage. Through the ACA, 20 million previously uninsured Americans (about 6% of the population) got coverage. However, the law did not add any new doctors or other medical professionals. That resulted in lower-quality care for the Americans who previously had insurance coverage.
The ACA attempted to mandate quality only allowing only insurance plans that covered a full range of services instead of any bare bones–type plans. They reasoned that this action would improve the quality of care since the goal was to have all Americans covered in virtually all situations, especially including preventative care.
For Dems, the priority was coverage, cost, quality.
Most Americans believe the country needs a new health care policy. Some believe we should start from the beginning, while others believe we can modify the existing system. Either way, until we get consistency of priorities, finding a solution that results in better health care at a reasonable price covering as many people as possible will be very difficult.
Michael Busler, Ph.D. is a public policy analyst and a professor of finance at Stockton University, where he teaches undergraduate and graduate courses in finance and economics. @mbusler www.facebook.com/fundingdemocracy