The electorate is right to put the issue at the top of its worry list, says a leading scholar and former advisor to U.S. presidents and policymakers of both parties.
Many polls during the 2018 midterm elections showed fast-rising health care costs to be the number one concern of voters. But President Trump gave health care short shrift in his State of the Union address, notably proclaiming that he had “eliminated the very unpopular Obamacare individual mandate penalty.” Republicans cheered, Democrats didn’t, and on the morning after the address, our nation’s decades-old health care reform challenges—crushing costs, inadequate access to care, and questionable quality—were there to greet policymakers in both parties at both ends of Pennsylvania Avenue.
Of course, lots of national problems—immigration reform to name one—are now mired in a dysfunctional form of partisan politics. But the midterm 2018 electorate was right to put health care first on its list. As even a quick look at the 2018 Medicare Trustees Report should suggest, no other issue has as much potential to single-handedly wreck our public finances without resulting in most of what we want by way of a humane and cost-effective health care system that serves us all.
Can we overcome the polarized politics of health care and find a way forward? I believe we can. From my days as research director for President Lyndon Johnson’s National Commission on Civil Disorders to my time in the Nixon administration, my work at the Brookings Institution to my service with the Manpower Development Research Corporation and the Rockefeller Institute of Government, I have spent most of my career as a public administration scholar-practitioner working with leading state and federal lawmakers, governors, and presidential candidates in both parties.
Expert analysis does not drive major policy debates or decision-making, and I have scars to prove it. Still, reliably nonpartisan knowledge resources can mute even the polarized politics of health care and establish a base on which arguments and claims about the size and character of the challenges facing our nation’s health care system can be seriously studied.
In a paper for the Partnership for Effective Public Administration and Leadership released last month at the Brookings Institution, I outlined a way leaders in government and both political parties could pursue a disciplined, fact-based process of defining and addressing the challenges at hand.
Among other things, the paper, “A Bipartisan Blueprint for Healthcare Reform: Affordable Care for All,” describes potential cost-control mechanisms, such as placing “reference-price” ceilings on what health insurers can charge. Controlling costs is a particularly fraught area for prescribing solutions to what ails our health care system, but as Brookings scholar Alice Rivlin, a former director of the Office of Management and Budget during the Clinton administration, notes in comments included with the paper:
“Nathan has taken on the daunting task of creating a blueprint for a comprehensive health financing system for the United States that could command broad centrist support. He is right that only a bipartisan plan can be enacted and successfully implemented in the current polarized political environment.”
The paper includes commentary from other public policy legends, notably the former domestic policy chiefs for Presidents Bill Clinton and George W. Bush, Bruce Reed and John Bridgeland, respectively; former Indianapolis Mayor Stephen Goldsmith; Professor Lawrence Mead of New York University; and Professor Marc Meredith of the University of Pennsylvania.
To move forward on this enormous challenge, I favor establishing a bipartisan special joint committee of Congress on health care costs, consisting of majority and minority members of each of the eight committees with jurisdiction for health care. They would have a staff and work closely with the Congressional Budget Office, instead of waiting until a law is passed to find out how it is scored. The joint committee could be established by law chartered to address specific questions by a date certain.
I know that my hope for bipartisan action on this policy terrain may seem fanciful. Contemporary communications technologies are as likely to compound partisan disagreements as they are to bridge them. The internet has made it possible for everyone to play politics, even in their pajamas. But there are two sides to the instant-communications coin, and it is not inconceivable that good ideas about how to make America’s health care system work better and cost less for all might attract strange bedfellows. Alice Rivlin, a scholar-practitioner who has advised leaders in both parties, said it best: We need a “starting point for the necessary debate over how the warring advocates of different approaches to health reform can come together to rescue the American health system.”
We most certainly do.
Richard P. Nathan is a Senior Fellow of the University of Pennsylvania’s Partnership for Effective Public Administration and Leadership, and of the Nelson A. Rockefeller Institute of Government.