A visit to the doc to check on an ailment should be free.
Photo: John Collier Jr./Library of Congress
To a considerable extent, the debate over health care policy between the two major parties is very backwards-looking. Sixteeen years after the enactment of the Affordable Care Act, Republicans are still filled with rage by Obamacare. Some of them, in fact, would privately love to get rid of or radically shrink Medicare and Medicaid. As for the GOP’s “positive” health care proposals, it’s hard to avoid the impression that Republicans yearn to go back to the days when people took care of themselves and their extended families, paid cash for rare trips to the doctor’s office or the ER, and maybe put aside some money for a really rainy day–like, well, the day you get a cancer diagnosis.
But Republicans aren’t the only ones living a bit in the past on health care policy. Most Democrats mainly focus on fighting cuts or other changes to Medicare, Medicaid, and Obamacare, which is understandable given the GOP’s bad-faith approach to all these life-saving programs. Many who are inclined to think bigger or better often endorse Medicare For All or some other variation on single-payer health care. Given fiscal and political realities, the single-payer panacea is more of a statement of values and a way to meet a progressive litmus test than something anyone expects to enact in the near future. Medicare For All also doesn’t address problems in the health care system other than those involving private insurance.
So merits aside, it’s refreshing to see a Democratic think tank promote a new and someone different health policy idea: free primary care for all, as NBC News reports:
Searchlight Institute senior fellow David Bowen, a former Senate aide who helped craft the Affordable Care Act, said [free primary care] would be delivered either through that law’s marketplaces, expanding on the preventive services mandate, or through a new “public option” that the group is calling the “American Health Gateway….”
The ACA’s preventive services mandate requires most insurers to cover things like vaccinations and cancer screenings without charging a copay or deductible. Searchlight’s primary care proposal takes that much further: If a person shows up at the doctor and has an ear infection, for instance, the evaluation and prescription for that would be cost-free.
The definition of “primary care” in the proposal is a bit arbitrary, but it would clearly not include “surgery, hospital stays, cancer treatment or most specialized care.” But it would cover routine and acute care involving a broad range of health conditions, and would without question encourage more proactive health care and chronic disease management. Because it would be (ideally, at least), a universal benefit, it would not run into the many complexities and injustices associated with both Medicaid and Obamacare, with their means-tested limitations. And it’s not inconsistent with Medicare For All, and could be treated as an incremental step towards truly universal health coverage.
The free primary care proposal would also present Republicans with a new test they would likely fail, wedded as they are to the idea that copays and deductibles–or as they like to think of it, “skin in the game”–are essential to health care cost containment.
Perhaps down the road Democrats can supplement the insurance-focused proposals typified by Medicare For All with measures to address provider price-gouging and other abuses that drive up costs and build inefficiencies into the system. For now, though, free primary care is a welcome addition to a health policy menu that’s yellowing with age.
