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The Healthcare Election

Healthcare is the central issue in the 2020 election.

If Republicans are able to keep healthcare out of the conversation, they win. If Democrats make healthcare THE issue, they win – with one big caveat.

Insurers and hospitals are making record profits, while a family of four has to spend $21,000 before they get any coverage.

Healthcare is unaffordable for middle-income families without subsidies or employer support. In many areas, the cheapest bronze plan is around $13,000 and comes with an $8000 deductible. Before mom dad and the kids get any benefit other than preventive care, they’re out $21,000.

Rural Americans are more likely to have high-deductible plans. And, even if the premiums are subsidized, there’s still their monthly cost plus an $8,000 deductible.

That is, if they can find a provider when they need care.

121 rural hospitals have closed over the last 10 years – 44 in the past three years. with the biggest impact in states in the south and central US where the combination of under-insured patients and no Medicaid expansion has left many small facilities on the brink of bankruptcy – while dozens more have closed.

Meanwhile, back in DC…

There’s been zero meaningful progress on drug prices, an issue of particular concern to seniors. Likewise, all the talk about surprise medical bills has yielded exactly no solutions, as hospital lobbyists have successfully quashed meaningful reforms.

Millions of us have pre-existing conditions; we risk losing coverage – and paying much more – if the Trump-supported Texas lawsuit to overturn Obamacare is successful.

While consumers are getting hammered, hospitals, health systems, and health insurers are raking in the billions.  Near-record profits for insurers, and very strong margins for pharma device manufacturers and hospitals stand in stark contrast to flat wages for most Americans.

Here’s the caveat. Sure, Republicans have no solution to the healthcare coverage and cost crisis. But Americans – at least the ones who vote – don’t want Single Payer.

What does this mean for you?

If Democrats stay focused on healthcare reform and avoid Single Payer, they win.

If not, they lose.

4 thoughts on “The Healthcare Election”

  1. Hi Joe,
    I know this will be no surprise, but I disagree. Let’s see if I can go 2 for 2 on presidential election predictions! For better or worse, elections today are as much about perceptions as they are about facts, so while my points here may be arguable based on the facts, it is the perceptions that will make the difference with many at election time. The Democrats proudly and loudly “fixed” healthcare with the passage of the ACA. Even though many of the issues in health care we see today existed prior to that point (or to actions taken since that time), the Democrats will, in the minds of many, “own the problem.” The Republicans (Trump) will be successful in labeling most of today’s issues as being part of the “failures of Obamacare.” The debacle in Iowa will not help drive the image that the Democrats can be trusted to fix a major system like health care – again.

    Honestly, there is not a major candidate on the Democrat side today that will beat Trump in the general election. Bloomberg, as an “outsider” (which definitely fits the desire of much of the electorate today), would have the best chance, but I don’t believe he would ever get the nomination. I do think the eventual Dem nominee will be on the Single Payer Express, so we may never know if your prediction is right or not.

    The only thing that threatens the Trump train at this point is a stalling or faltering economy – or the perception of a stalling or faltering economy. To that end, look for the growing number of main stream media reports that point to “evidence of a looming recession” (which in reality is now overdue). Those reports will start up in early summer, even if most economic indicators remain strong. If the public believes that a recession is coming, the perception will affect the election; and might become a self-fulfilling prophecy.

    I just don’t believe health care will be the issue that drives it for the Dems.

    1. Hello Bob
      We agree about facts not being important. As I noted the Rs are in tough shape re healthcare IF the Ds get their messaging act together.
      It’s not about the past. It’s about the future of healthcare.

  2. Nice article as usual Joe. I agree but not sure health care will move the needle of most voters. I know some that voted R and Trump who are not happy about the R’s doing nothing and will not vote for them again. However, I am not sure this is the majority. Will see if the Dems can convince the voters and come up with a better alternative.

    As a health care provider I can verify the system is really broke. It is not working for the average Joe or the private practice providers. It may be working well for the big hospital systems and the commercial insurance carriers that I have no doubt. The big 5 commercial payers are making record profits while small providers are pinching pennies. They drop what they pay us and raise our premiums and the deductibles of our employees yearly. This has been going on since the early 2000’s. We get an interesting perspective being both a health care provider and employer. Regardless I am convinced that greed and capitalism do not go hand in hand. Let me say I believe in capitalism but not in health care. $$ signs win out every time over covering an insured’s medication or chemo therapy. Good health and wall street profits are really not compatible. The system is fixed and unfortunately something needs to be done to break it up. Rather than creating universal health via a Medicare like program why not create private non profit insurance carriers that do not have to report to shareholders? Or a hybrid of some sort for those who the current system may be working for? Just a thought.

    1. Mark
      Thanks very much for your observations. All should read and think about your perspective; some are doing very very well while others are not.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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