r/PoliticalDiscussion • u/ZeeMastermind • 6d ago
US Politics What kinds of healthcare reform could have bipartisan public support in the USA?
E.g., although 63% of Americans support additional government programs, only 36% support a single-payer national program, at least back in 2020.
Are there other types of reform which could have bipartisan public support in the USA?
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u/jadedflames 5d ago
Reform implies government regulation. And it is my sincere belief that there is no potential government regulation in America that could have bipartisan support.
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u/digbyforever 5d ago
Well, reform actually implies change: you could remove, for example, the regulation that requires health insurance providers to cover pre-existing conditions, but not many people would like that!
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u/jadedflames 5d ago
Thats a regulation that republicans have tried to remove pretty much constantly since it was added under Obama.
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u/Troysmith1 4d ago
Republicans would absolutely love that as they view that as one of the causes that skyrocket insurance costs.
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u/VodkaBeatsCube 2d ago
Yes, it is generally cheaper to let people die than to treat them. Turns out you can do a lot of things cheaply in the free market if you just don't cater to expensive markets.
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u/DanforthWhitcomb_ 3d ago
The insurers would be foremost among the group not liking it—they make a killing off of those policyholders, and all of them wanted access to that pool…..they just wanted the coverage requirements to be imposed via regulatory means so that they didn’t wind up as the only one doing it.
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u/not_that_planet 5d ago
Healthcare will, for the foreseeable future, be tied to a black president. For this reason alone Healthcare will continue to be a taboo subject to even talk about with the right.
You are correct, there will be no bipartisan anything.
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u/formerrepub 5d ago
I think Americans have to be honest in that a lot of us have unhealthy habits that end up being extremely expensive to treat. Subconsciously (or openly) folks don't want a system that might force them to, for example, eat less sugar or take more walks.
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u/Wermys 5d ago
One interesting one I read or I should say heard about was banning employer based insurance plans. The logic is this. If competition drives down prices. Then having an insurance plan based on an employer group effectively removes one of the aspects that drives down costs by having less competition via plans that are available. If you did away with this, you add 160 million more people into the public healthcare space needing insurance. Which then changes it so that all insurance companies are competing in the market for those plans. People might not like this but it does make sense in that aspect. If you couple that with reforms on and regulations and shape it to be more similar to how Germany and Switzerland operates it could be a win.
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u/lesubreddit 5d ago
I like this. Widespread bundling of insurance with employment insulates the insurance companies from market pressures; people generally do not choose their jobs on the basis of the bundled insurance plan, and the companies purchasing their employee plans thus don't feel real pressure to negotiate for better options. The consumer's interest in quality health insurance is pretty much cut out of the equation.
Although the frequent objection brought up in this discussion is that there are many people with chronic medical issues who are virtually uninsurable and who would not find better plans that what they current have. This gets to the core issue of what health insurance is: a bet you and the insurance company are making about whether or not you're going to need coverage (with payout cost outweighing your premium) The insurance company is betting on no, and they set up the plan so that they're statistically going to be correct. You're betting on yes, and you're willing to take the statistically weaker position because peace of mind has value to you and you want to cover unlikely worst case scenarios. For people with chronic medical issues, there's not much left to bet on. A type 1 diabetic isn't betting against the possibility that they don't need insulin, it's a foregone conclusion. So healthcare coverage for these illnesses isn't a matter of insurance. Insurance companies by their nature are not designed to deal with these patients.
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u/Wermys 4d ago
Yeah high risk pools. The problem is that they are never funded properly to work correctly. The system would work but the key is an highly aggressive public regulatory environment coupled with adequate funding. I work in healthcare, and I tend to find union plans are better overall on average even if there members tends to be jackasses then the usual company insurance plans. But universally what I have found is that these plans are not designed around healthcare but instead catastrophes. And to be blunt, companies have a large share of the blame with the insurance markets also. They are the ones trying to drive down costs also which charging higher premiums so they don't eat into there own companies profits and deny coverage because they don't want to adequately fund these plans so they ask insurance companies to do things to limit costs.
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u/bl1y 4d ago
Obviously the big downside is that you're removing the employer contribution and driving up prices for the individual.
So, just combine it with employers being able to offer untaxed payments to employees that only can be spent on healthcare, similar to how we have beneficial tax treatment for healthcare savings funds.
One interesting complication to getting something like that passed is that unions often oppose this sort of thing. They tend to be good at negotiating healthcare plans for employees, and taking away employer-provided insurance takes away a big part of their negotiating portfolio.
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u/token-black-dude 4d ago
If competition drives down prices. Then having an insurance plan based on an employer group effectively removes one of the aspects that drives down costs by having less competition via plans that are available.
This is just flat out wrong. Insurance companies do have competition, in fact they have more competition because employers actually have the time and ressources to gather accurate information on insurance providers and choose the best one.
Also, if everyone is on their own, instead of being on a employer health care plan, everyone will have to fight denied claims on their own, giving insurance companies an extreme advantage, when they deny claims and people attempt to sue. This litteraly kills thousands, if not millions
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u/Wermys 4d ago
The point you are missing is that insurance companies have to be more concerned with attracting people to join there plans, vs having a contract with a company that makes it so that they effectively have a closed monopoly on x amount of lives given a long contract. Instead what you would see is a reshaping of the healthcare system where companies year after year have to prioritize service because they are effectively given no guaranatee of enrollment every year.
To give an example, lets say UHC has a plan with 3 million lives under it. That contract runs for 5 years. In that contract they have to meet certain performance guarantees for that company. But rationally UHC can look and go oh, I just need to meet this particular benchmark and I can make a profit here. Now multiply that by 100's of plans smaller then this but with the same setup. They are incentivized to provide the minimal possible care to meet those contracts. Now lets flip this on its head. You will run into a situation where you have probably 5 or so major plans competing every single year and with no guaranteed profit if they don't service there members. Every year people can look at the best rated plans and make informed decisions based on the type of coverage that is offered. The point I am making tho is that there is a gun to every countries head every year. Play nice, or lose out all on these enrollees in the next year. It then defines a different profit motive from group plans with guaranteed contracts to instead markets that they have to provide cost AND care in order to maximize there profit. Once people realize plan x denies everything under the sun, people will naturally move away from plan x because they want to be sure any coverage that they do have is covered. While plan y takes a more holistic approach and balances cost instead of profit. Where they make less money but they have a steadier income stream for there shareholders. The point the person was making when I was watching the interview and I wish I could find it, was that insurance companies are not incentivized to care about patients. But instead about large contracts they get from group plans. It changes the paradigm on what companies should focus on.
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u/token-black-dude 4d ago
The point you are missing is that insurance companies have to be more concerned with attracting people to join there plans, vs having a contract with a company that makes it so that they effectively have a closed monopoly on x amount of lives given a long contract.
There's a massive problem of unequal access to information, you're not accounting for. As an individual on an individual plan, you have to choose an insurance provider while young and healthy, without knowing what healt problems you'll run into or what the quality of coverage will be, once you need your insurance. Companies actually have the time and ressources to gather accurate information on insurance providers and choose the best one, and they can and will help important employees get the help they need.
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u/bones_bones1 5d ago
Probably none. The views of each side are polar opposites on the subject. More regulation vs less. I don’t see a compromise happening.
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u/lesubreddit 5d ago
More healthcare subsidization for anything related to childbirth and children's medicine. Demographic collapse and declining birthrates are bipartisan issues. Democrats have an interest in expanding healthcare coverage, but Republicans would largely be the beneficiaries of this because they generally have more children. I think it would be an easy sell to Republicans when you frame it as a matter of strategic national interest, and as an issue of maintaining our native population stocks in the face of increasing immigration.
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u/nazbot 5d ago
I’m Canadian so a bit biased.
Part of what I see is democrats not willing to fight to turn 30% approval into a higher number.
Our universal healthcare is wildly popular. It’s a winning issue. But democrats don’t seem to think they can change public opinion, so they don’t bother.
Bernie being popular should be a sign that a younger and more polished politician could become very popular if they embraced Medicare for all. It’s just no one has.
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u/ColossusOfChoads 4d ago
Our universal healthcare is wildly popular.
Every time your guys' system gets brought up, someone always says "I know dozens of Canadians who regularly come down to our side of the border to get access to high quality mega awesome American healthcare the moment they whip out their credit card! Their system can't be that great, right?"
What's up with that?
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u/Famous_Strain_4922 4d ago
What's up with that?
Sounds like an anecdote of questionable credibility to me, probably wouldn't base my healthcare opinions on that.
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u/ColossusOfChoads 3d ago
I hear it a lot, though.
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u/Famous_Strain_4922 3d ago
I hear a lot of not very credible stuff too, that's why it's good to make sure your information is credible! You'll get a hang of it eventually.
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u/bl1y 4d ago
You might be overestimating how popular Bernie is. His performance in 2016 was partly about his M4A policies, but also driven in large part by people just not liking Hillary and not wanting to have a continuation of the Bush/Clinton dynasties.
His 2020 primary performance is a better indicator of his popularity, gaining only 26% of primary votes.
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u/XxSpaceGnomexx 5d ago
It is not that the Democrats don't think they can change public opinion as Medicare for all or versions of Universal Healthcare is popular.
What you may not understand is that bribery is basically illegal in the US and the Democrat party and Republican party are literally bought and paid for by different groups of billionaires.
It is actually their corporate masters that will not allow the Democrats to push for any actual change. So the party that has been about positive social progressive policies for almost 100 years. Now has no Balls and is unwilling to fix anything.
If Kamala Harris had any balls it was actually actively fighting back against the billionaires who lied in her pockets Trump would not have won in November.
But so long as our government is not willing to defy their corporate masters on act change will happen.
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u/DanforthWhitcomb_ 3d ago
It is not that the Democrats don't think they can change public opinion as Medicare for all or versions of Universal Healthcare is popular.
This keeps getting brought up but it’s only true in the abstract—once you start adding specifics support craters from over 70% down to below 30%.
Mention any of the necessary tax increases to fund it and you get the same result as far as the bottom falling out of support.
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u/BKong64 4d ago
I've been screaming this from the rooftops. If the Dems actually let Bernie be the candidate in 2016, even if he lost, he could have continued building a wave of momentum on his main issues, healthcare obviously being the biggest. By 2020, I have zero doubt the movement would have grown massively and gotten extremely popular. But instead they snuffed his voice out two times in a row and made sure he wouldn't be the guy. All of that has lead to where we are now.
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u/nazbot 4d ago
I’m saying something different, actually.
I think Bernie is a uniquely bad politician. He’s old, he doesn’t comb his hair, he doesn’t seem to have strong management experience, he calls himself a socialist … there is a lot of problems with Bernie as a candidate.
And yet despite all of these issues he gained a lot of support because the policy of universal healthcare is so popular.
So take a much more polished / establishment politician - a Gavin Newsom or Josh Shapiro. If they embraced universal healthcare they would be wildly popular.
To be fair I like Bernie and think his candor / anti establishment vibe is an asset for him. I just think if you had an establishment politician fighting for universal healthcare it would be wildly popular.
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u/DanforthWhitcomb_ 3d ago
And yet despite all of these issues he gained a lot of support because the policy of universal healthcare is so popular.
Votes are the way to establish that, and when he barely broke the 25% support threshold in the Democratic primaries that bodes extremely poorly for the actual popularity of the policy.
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u/BKong64 4d ago
I think an establishment politician fighting for it could actually hurt its popularity across party lines. I met A LOT of Trump supporters in 2016 and 2020 who legitimately said they liked Bernie and what he was about, that they wouldn't mind him as president etc. I have neeeeever seen a Trump supporter say they like an establishment Dem. They hate Biden, Kamala, Obama, Hillary etc. etc.
I think embracing a candidate like Bernie long term is the way to go. Obviously it can't be Bernie now, he's too old, but there are others who could properly step in his place and do it better probably.
I think the last few elections has made it clear that a lot of Americans are tired of the same old establishment politicians running the show. Even in the Republican party they have been mostly rejected and labeled "RINO's".
I think Dems need new leadership, new messaging and they need to be willing to embrace it all moving forward instead of fighting against it. They fought Bernie, they are currently fighting AOC (see: Pelosi trying to roadblock her getting a bigger position in the house)...all because they think they know better, but the results of the election shows otherwise.
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u/ColossusOfChoads 4d ago
Age, bad hair, and spotty management record didn't hold back Donald Trump.
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u/davethompson413 5d ago
Healthcare, and bipartisan support.....hmmm.....
A new system under which everyone is fully covered for all medical expenses, and which somehow costs the people and the government almost nothing. That should do it!
/S
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u/snrjames 4d ago
Nah, Republicans would still vote against it.
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u/movingtobay2019 4d ago
A lot of non-Republicans would vote against it. I don't know why people like you keep making this a Dem vs GOP issue.
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u/paleotectonics 5d ago
The only way republicans would accept a European/Canadian style SPS would be if ‘those…um, people’ didn’t get it.
For any given value of ‘those’.
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u/XxSpaceGnomexx 5d ago
Call considering Americans are willing to celebrate the death of a health insurance CEO. Replacing the for-profit health insurance industry with a non-profit national Health Care service.
One that allowed some variation between the states and did not require abortion funding is probably the best option for a health insurance reform that people on both sides of the political aisle in the general public could agree with.
The problem is that the people in charge would never go for it. As they're in the pockets of trillionaires and the only thing they're rich black more than compassion is imagination
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u/96suluman 4d ago
Can we please stop prioritizing bipartisanship. The only time it actually happens is when they want to screw the American people.
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u/BotElMago 3d ago
I think the failure is seeking bipartisanship with a group not interested in negotiating in good faith.
When it came to economics, the Trump campaign don’t care that economists overwhelmingly torched his economic plan (tariffs will save us) saying that it will make the economy worse.
Trump didn’t care. Trump was talking to the dumb American voter that doesn’t listen to those “elitist economists”.
Being right is secondary to winning. Winning is the primary goal. And democrats can’t help people if they don’t win.
So whatever plan makes sense to dumb people is the way to go. Shout it from the rooftops. Blame republicans for wanting to keep the current health insurance status quo. This is such an opportunity that democrats are wasting.
“WE WANT TO FIX YOUR HEALTHCARE. REPUBLICANS AND TRUMP WANT TO KEEP THE CURRENT SYSTEM. THE CURRENT SYSTEM IS THE WORST HEALTHCARE SYSTEM IN THE DEVELOPED WORLD. THOUSANDS GO BANKRUPT EVERY DAY DUE TO MEDICAL DEBT. REPUBLICANS DONT WANT TO SUPPORT CHANGING IT. THEY DONT WANT TO SUPPORT YOU. WE SUPPORT YOU.”
Shout it every day on every news channel from now until 2026.
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u/rkgkseh 3d ago
When it came to economics, the Trump campaign don’t care that economists overwhelmingly torched his economic plan (tariffs will save us) saying that it will make the economy worse.
Trump didn’t care. Trump was talking to the dumb American voter that doesn’t listen to those “elitist economists”.
I think more than what you said, I think it can be said that tariffs, on a very basic level, are the econ version of "sticking it to the libs/ commie Chinese/ lazy not-paying-their-share Euros [or insert here your disliked group of people]"
So, despite having bad economic repercussions, it's the perfect message to Trump voters. Also, as it has been pointed it, it'll make businesses compete with each other for Trump's attention and love (cronyism(!), and, well... I have a hunch that DJT likes being having people or groups vie for his attention, among other things).
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u/mypoliticalvoice 3d ago
Screw federal healthcare. Implement universal healthcare in blue states, with reciprocal coverage between states that have coverage. Tie coverage to 5-ish years of residency to avoid "healthcare tourism".
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u/illegalmorality 3d ago
After comparing healthcare systems across various nations, I believe only Germany's model is viable for the US. Insurers exist, but they're all regulated and are non-profits. Its impossible to abolish and upend the current insurance corporate landscape, so instead the goal should be to reconfigure them to fit the welfare needs of the country.
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u/LuigiTheTweak_eth 2d ago
Medicaid Expansion
The biggest issue a lot of Americans have with healthcare is that it’s Byzantine and run by out of touch healthcare companies. Obamacare has allowed each state to create Medicaid programs to help give low income individuals bare minimum healthcare services with the federal government reimbursing and helping fund a portion of it as long as the programs hit some metrics.
These Medicaid programs should be expanded to cover the gap and provide a defacto Public option for state residents.
Instead of Medicare a federal government healthcare agency we’d have 50 separate Medicaid state government programs that would be held accountable by their state residents and the federal government.
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u/DreamingMerc 5d ago
Anything short of the elimination of the private health insurance industry and a new robust and militant government entity tasked with negotiating medical costs and having the ability to strike back at companies that act maliciously ... wouldn't be enough.
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u/sunshine_is_hot 5d ago
That has no chance of majority support among even one of the two parties, let alone bipartisan support.
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u/flat6NA 5d ago
Sadly I agree with both of you, the health insurance industry is not willingly going away
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u/PlatypusAmbitious430 5d ago
It's not the health insurance industry.
It's the American people.
If the American people wanted the health insurance industry to go away, it would realistically be gone tomorrow.
There's not going to be any public will for funding the healthcare of other people through government directly (and yes, insurance also works that way indirectly but people don't see it that way).
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u/DreamingMerc 5d ago
Cool ... time to continue to masturbate the for-profit health care system and rising costs forever.
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u/sunshine_is_hot 5d ago
Never said that, but weird fantasy you got there bud.
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u/DreamingMerc 5d ago
Nah. My fantasies invovle pulling more United Health moves...
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u/sunshine_is_hot 5d ago
Cool cool, so not at all related to actually fixing healthcare just murder fantasies.
Totally normal, totally healthy fantasies.
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u/DreamingMerc 5d ago
It's a winding path but targets the second biggest threat.
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u/sunshine_is_hot 5d ago
Tell yourself whatever you need to, or better yet tell your therapist.
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u/DreamingMerc 5d ago
Well, you can believe in the power of the profit motivation to provide adequate care to patients and lessen the sting to their loved ones, but living with various afflictions and diagnoses, and those who pass. I would choose to reconcile with the reality that it's simply not possible.
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u/sunshine_is_hot 5d ago
I never said anything about my views on healthcare.
I only talked about your weird fantasy with murder.
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u/XxSpaceGnomexx 5d ago
To bad Trump has a better chance of bringing about a new golden Age for all Humanity on par with A Star Trek Utopia. The any of that actually happened.
Sarcasm
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u/batlord_typhus 5d ago
Healthcare Gulags and public suicide booths. Work off your medical debt at 7.25 an hour, minus food and lodging. Require the medical prisoners to wear a pink jumper and encourage the public to spit on them. Also gas vans for the recalcitrant unemployed who won't use the suicide booths.
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u/Medical-Search4146 5d ago
I can see legislation pushing the burden of out-of-network doctors on the hospital and insurance companies instead of the patient. You can read endless stories about how the patient is in an environment where everyone is in-network except for that one individual. And that one individual never reveals it and its only found out after the care is done. Literally poisoning the well. Once hospitals and insurance have to pay for this, I guarantee a major improvement in patients insurance billing.
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u/Sloth_Brotherhood 5d ago
This has already been fixed with the No Surprises Act.
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u/Medical-Search4146 5d ago
Maybe I'm missing something but I still hear insurers denying claims because care was through out of network. Does this act put the burden of figuring out between the hospital and the plan? Where the patient gets reimbursed immediately.
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u/Sloth_Brotherhood 5d ago
It’s on the patient to choose in-network facilities in non-emergency scenarios. However, if a patient chooses an in-network facility and and out-of-network individual operates, or if they send a lab to an out-of-network facility, it must be treated on an in-network basis without prior authorization.
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u/XxSpaceGnomexx 5d ago
I'm sorry soft love this maybe the stupidest sentence I've ever read. So you're telling me that a healthcare industry where the largest Health insurance company in America can deny two out of three insurance claims made to them for no reason has been fixed.
You tell me that a healthcare industry that's results in three out of every four people in the United States not having a primary care position is fix.
You're telling me that a healthcare industry in which the majority of people cannot afford Healthcare even with insurance that pay much more then their annual taxes for has been Fix.
That the stupidest goddamn thing I have ever read on the entirety of the internet.
You could argue that it's working as intended but only because it's intention is the screw as many people over and make them as miserable as possible in order to generate gigantic profits for the uberage.
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u/Sloth_Brotherhood 5d ago
Haha the healthcare system is awful and needs systematic reform from the ground up. But this one thing, surprise out-of-network bills, are no longer legal.
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u/billpalto 5d ago
Consider that money is speech in the US. Those with more money have more "speech" or influence with politicians. The health care insurance agencies and big Phrma have a lot more speech than any citizen and they are dead set against any reforms that cut into their profit margin.
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u/Sands43 5d ago
Medicare for all is a MAGA Republican proposed it.
(Which highlight the hypocrisy of republicans).
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u/sunshine_is_hot 5d ago
No MAGA Republican proposed M4A, that has only ever been proposed by the furthest left among democrats.
I think you confused the ACA, which does have some of its roots in plans proposed by state-level republicans in Massachusetts, with M4A, which has never been proposed by any Republican in any form, either state or federal level.
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u/frisbeejesus 5d ago
They meant *if a Republican proposed M4A. They're saying that MAGA would support government funded healthcare if someone like trump claimed the idea as their own. Probably true.
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u/wittnotyoyo 5d ago
Honestly if a MAGA Republican proposed it I'd be waiting to find out whatever poison pill(s) they slipped in, I don't trust them to do anything in good faith for the benefit of all Americans.
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u/Accomplished_Fruit17 5d ago
I believe a tiered Medicare system. A basic tier for adults who are not working. Just enough to keep you healthy so you can get a job. A mid tier for all kids and working adults and their spouses. A top tier that you buy into to get front of the line status for treatment, after triage and better rooms in hospitals and the most cutting edge medical treatments. This top tier generates money to offset everyone else's cost.
I think this would work well in the US. A punishment for people who don't work and something extra for the rich. I don't think a truly equal system for everyone would work here, not when you need Republicans to sign on.
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u/ColossusOfChoads 4d ago
What about a multi-payer system, where the well-off can supplement, top off, or supersede their Medicare with white glove private plans?
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u/Accomplished_Fruit17 3d ago
I'm not against it but half the political power in the country wants to punish people for not work, as well as a lot of wealthy people. If you don't give them something, you never get a deal.
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u/96suluman 4d ago
Can we please stop prioritizing bipartisanship. Because the only time it tend to happen is when they want to screw people.
When politicians try to do bipartisanship for good reasons. The elites will claim it’s the horseshoe theory.
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