After Obamacare: The Next Democratic Health Agenda
Obamacare faced ferocious opposition from the right, but the underlying idea — get more people signed up for coverage — was one that public health advocates and liberals could rally behind. Now, as the priority shifts to quality and cost, the policy problems become much more difficult to tackle and the solutions less clear.
Policies that reduce cost systemwide often leave consumers paying more out-of-pocket for health care. That can split coalitions that came together around the more unifying goal of covering the uninsured.
Building coalitions in the multi-billion health-care industry, where each stakeholder has different priorities, is excruciating work. A litany of failed attempts at health reform (including Hillary Clinton’s own 1994 efforts) provide a gloomy backdrop. So some are skeptical that, after the Obamacare battle left many badly bruised, health care will become a prominent agenda item on the next Democratic president’s docket.
Just like Obamacare, the battle to lower costs will require new coalition building, and risks turning one-time friends into enemies. The doctors and hospitals who benefit from expanded coverage — and a wave of new consumers — are the exact same constituencies that stand to lose the most if America spends less on medicine.
But in this new round of reform, insurers arguably stand to be one of the biggest winners. They benefit if costs go down because they can sell less expensive coverage — and that makes them the more natural partner of Democrats in this new era of reform.
“There is sometimes a Washington perspective that ‘the Democrats did health care,’” Emanuel says. “You don’t ‘do’ health care once. You do health care forever. It’s not a marathon. It’s life.”