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Hello, Bulwark readers!
Remember when, a few days ago, I wrote about how Democrats and their advisers were having a series of conversations about a new agenda for health care reform? Well, some of those conversations are further along than I was able to report at the time, and the people leading one of them are about to put forward a proposal. They’ve shared it with me exclusively, and I’m now sharing it with you.
I’m hoping this will be the first of many such articles in which I can write about the ideas that politicians hope can be the basis of a post-Trump governing agenda. Now is the time to pitch and debate such ideas, because it takes a while to figure out what works as policy and politics.
Partly for that reason, I’m going to describe these ideas and then the obvious questions about them without injecting too much of my opinion—at least for now. Serious proposals are inevitably complex and full of tradeoffs. It’s tough to assess them quickly, especially when they include genuinely novel concepts.
By the way, if you happen to be somebody who is working on such a plan—for health care or any other domestic policy area, from the left or the right or somewhere in between—I’d love to hear about it! You can email me at cohn@thebulwark.com. And if you happen to be somebody who likes reading about these nitty-gritty policy efforts, you should consider becoming a Bulwark+ member to support our efforts in covering them. We’d love to have you aboard:
–Jonathan
Exclusive: Top Dem Think Tank Unveils Next Big Health Care Push
A new “patients’ bill of rights” from the Center for American Progress.
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A PROMINENT THINK TANK with close ties to the Democratic establishment is about to unveil a proposal designed to do just that.
On Wednesday morning, the Center for American Progress will introduce a set of proposals to limit what hospitals and insurance companies can charge, while also limiting the ability of insurers to deny coverage that doctors recommend to their patients.
The proposals, which CAP senior staff shared exclusively with The Bulwark, aren’t fully fleshed out in the way, say, a bill in Congress would be. It’s a starting point for future legislation—a set of ideas that political leaders could debate and refine, tout on the campaign trail and, eventually, attempt to pass into law.
CAP is widely known as the unofficial policy incubator for moderate-to-liberal Democrats, which means its proposals are likely to get a serious hearing in Washington. Veterans of past Democratic administrations are heavily represented in the group’s upper ranks. Many would probably end up back in the executive branch—or with jobs on Capitol Hill—if Democrats get control of either or both in upcoming elections.
And insofar as CAP’s agenda is indicative of where the party establishment’s brain is right now—or, at least, where CAP current leaders would like it to be—this new proposal signals a few important shifts in thinking about health care.
For one thing, the focus of this new agenda is very clearly on improving affordability for everybody, rather than getting coverage for those who are uninsured. “If you want to address people’s concerns about health care, their concerns are driven by high health care costs,” CAP president Neera Tanden told me in an interview. “It’s important to put forward ideas that will help the 91, 92 percent of Americans who have insurance.”
Tanden said the decision to focus on costs didn’t mean CAP was backing off its commitment to universal coverage. “We believe health care is a basic human right,” she told me. Nor did Tanden suggest deemphasizing the importance of reversing GOP cuts to Medicaid and the Affordable Care Act, which together are projected to leave tens of millions of Americans either with more expensive coverage or altogether uninsured.
But, Tanden and her colleagues said, it was important to address the cost issues as soon as possible. They also said it was important to address sources of everyday frustration for those who are already insured, especially when it comes to denials of treatment that, in the worst of cases, can make it difficult for people to get the care they need.
“It doesn’t mean we shouldn’t talk about expanding coverage—that’s always going to be a part of the agenda,” Topher Spiro, a CAP senior fellow who oversees health policy, told me. “It’s just a recognition that we’re at a breaking point on costs . . . and we need to take that on.”
The CAP plan seeks to accomplish that by having the federal government get a lot more aggressive about using its regulatory power to hold down costs. Mainly it targets hospitals, by attempting to set a ceiling on what they can charge, and insurers, by putting new limits on their ability to raise premiums. There’s also a set of provisions that would change the way insurers review recommended treatments for approval, in some cases removing altogether their right to block specific treatments.
CAP is billing the proposal as a “patients’ bill of rights,” on the theory that it would protect patients from both unfairly high costs and unfair scrutiny of their medical care.¹ And like any such proposal, it’s sure to draw objections from serious people who think it would do too much or too little, or simply wouldn’t work well.
But whatever its virtues or flaws—both worthy subjects of future debate—the proposal represents an important departure from the status quo. To see how and why, it helps to understand a sharp turn in policy that took place about fifty years ago.