Our Progressive Vision: Every American should be able to get the health care they need, when they need it, at a price they can afford. But for years, insurance companies charged too much, their policies were full of holes, and coverage was easily denied or revoked. The Affordable Care Act changed that, providing families with a measure of health security. Now that the ACA is under attack, there is much to be done: (1) guarantee coverage to every American as a matter of right; (2) encourage healthy behavior and protect others from unhealthy behaviors; and (3) allow people to make their own health care choices.
Health care for all
Thanks to the Affordable Care Act (ACA), about 23 million more Americans had health insurance in 2016 compared to 2010 and the percentage of uninsured Americans was reduced from 16 percent to less than 9 percent. The ACA would have covered millions more, but conservative governors and state legislatures blocked the law’s Medicaid expansion provision in their jurisdictions. After the 2016 election, the incoming Administration and the new Congress pledged to repeal the ACA. The Congressional Budget Office estimates that such a repeal and the resulting market collapse could take health coverage away from as many as 30 million Americans. Each state and locality needs to prepare to protect the health insurance of as many residents as possible. One step is to create a study commission to report on the likely healthcare and economic impacts of ACA repeal and recommend policies to help people become or remain insured.
Encourage healthy behaviors
Preventable behaviors such as tobacco use, poor diet and physical inactivity, and alcohol or other drug use are the underlying cause of half of deaths in the United States, according to a recent study. A progressive government encourages healthy behaviors while leaving ultimate decisions to the individual. The biggest preventable killer remains tobacco, which claims more than 480,000 victims every year. Jurisdictions can discourage smoking by raising the tobacco tax, implementing workplace smoking and e-cigarette bans, increasing the minimum age to purchase tobacco, and offering smoking cessation programs. States, localities and school boards can improve nutrition and physical fitness programs available in schools and also increase opportunities for athletics, walking and biking in communities. States and localities can raise alcohol taxes, crack down on sales to minors, and rethink whether their drug laws and enforcement systems are an efficient way to discourage the use of dangerous drugs.
Let people make their own healthcare decisions
Too often, people who are sick or dying are not given choices that should be theirs to make. If a doctor thinks that a patient with glaucoma, multiple sclerosis, nausea from chemotherapy or chronic pain would benefit from medical marijuana, the patient should have that choice. If patients would benefit from palliative care, they should be told. And if a terminally ill person wants to have some control over the time of his or her own death, that should be their decision, not the government’s.
E-cigarettes are battery-powered devices that mimic cigarettes. A heating element vaporizes a nicotine liquid, which is inhaled by the user. Both the benefits and risks of e-cigarettes are rather uncertain, but nicotine is certainly an addictive substance and some teenagers who were otherwise nonsmokers are using e-cigarettes. Nine states and more than 500 localities have specifically applied workplace smoking bans to e-cigarettes, in part because their safety is not established and because their use causes confusion as to where smoking is allowed.
End-of-life palliative care
All too often, terminally ill people are not provided adequate information about their physical condition or counseling about palliative care and end-of-life options. Too often they feel abandoned by the healthcare system and suffer unnecessary physical or psychological pain. People have a right to know when treatments offer only a tiny chance of prolonging their lives for a few weeks or months. And they have a right to know about palliative therapies which could make them feel a lot better for their remaining time. A few states now require healthcare providers to address the needs of the terminally ill. In New York, for example, when a disease is terminal and patients are unlikely to survive six months, doctors must inform them of this, and advise them of available medicines and treatments that comfort rather than cure. Palliative treatment can ease anxiety and pain, and can be administered at home, a hospice, or a specialized hospital unit. A good law also encourages the creation of interdisciplinary palliative care teams to provide medical, spiritual, psychological and practical support to patients and their families. And just incidentally, by eliminating medical procedures that patients don’t want, it also saves many millions of dollars.
Promote lower costs for prescription drugs
While the inflation rate was less than one percent in 2015-16, drug prices climbed by more than ten percent. Prescription drug costs are the fastest-growing component of health care in many jurisdictions. Vermont responded with a law that requires drug companies to justify the most egregious Rx price increases. A new model from Maryland would require major drug companies to disclose how much they spend on production, research and marketing, and how much they keep as profit. It requires public notice when companies plan to raise drug prices by more than ten percent, and it allows the Attorney General to go to court to prevent price gouging.