Winning the Healthcare Debate


Who is winning the healthcare debate? Based on the mid-term elections, it seems that Democrats are winning. Is this correct and is it good for the country?

These are critical questions as we move into the 2020 presidential election campaign. The winners in the healthcare debate should be those whose ideas will benefit the healthcare of the citizens most. But that may not be happening.

John C. Goodman, healthcare economist writing in Forbes, thinks the Democrats are winning the debate – but not because they have the best ideas. He blames Republicans for losing because they are always on the defensive and do a poor job of explaining their ideas.

Goodman says the Republicans, under President Trump, have recently done three things that help liberate people from the burdens of ObamaCare:

  • Eliminated the Individual Mandate
  • Allowed purchase of short-term insurance (STLDs)
  • Allowed Association Health Plans (AHPs)


These three changes are making healthcare more affordable for millions of Americans. The Council of Economic Advisers (CEA) reports that the people who benefit from these changes will experience a gain worth $45 Billion a year! The CEA concedes that this will lead to slight rises in premiums for middle-income enrollees as healthier people exit ObamaCare, but the benefits to those who gain far outweigh the costs to those who lose.

But Democrats use emotional talking points to overcome facts and reason. They argue that these Republican reforms weaken protections of ObamaCare. Although only about 5% of people with private insurance are buying individual plans, the vast majority, who have employer-provided plans, view the individual market as the market of last resort. Therefore, they vote on emotional reactions to the Democratic scare tactics even though they are not affected.

Goodman says these Democratic scare tactics will continue to be effective in the healthcare debate unless Republicans come up with better answers. He points out four Republican mistakes:

  • Republicans are usually unable to explain why young, healthy families choose “skimpy” plans (STLDs) over “comprehensive” plans (ObamaCare) and why that is the right choice, even when the out-of-pocket premium is the same.

Low-income, healthy families would always prefer a lower-deductible plan even if the total coverage is much less. They don’t have the money to afford high deductible plans that offer much greater coverage and they don’t worry about high expenses from serious illness. ObamaCare forces them to purchase high-deductible comprehensive plans but they prefer the STLDs because they can afford them.


  • Republicans do not seem to understand that public insurance and private insurance must complement each other, and they are unable to explain how the complementarity is going to work when they advocate limited benefit insurance.

Sometimes public sector funding does a better job than private funding. Rare birth defects and substance abuse including alcoholic mothers are good examples. Goodman suggests public coverage for these conditions be available for everyone and only an option in private insurance. Otherwise, private insurance gets too expensive.


  • Republicans have never been able to explain convincingly how care for people with pre-existing conditions will be just as good or better under any proposal they have ever favored.

To counter this problem, Pete Sessions, Mark Meadows and other House Republicans proposed a House resolution on pre-existing conditions last year. It said that in any reform of ObamaCare, states must:

  1. Guarantee that people with health problems will get better health insurance.
  2. Set as an attainable goal: People who migrate from the group market to the individual market should be able to find similar insurance in terms of price, quality and access to care.
  3. Allow health plans to specialize and offer better care for such conditions as cancer, heart disease and diabetes.

 This is a good way to assure voters they are looking out for them.

  • While everyone agrees that the healthy subsidize the sick under ObamaCare, Republicans have never explained the alternative. Who should subsidize the sick and how should that subsidy work?

Most Americans get their health insurance from their employer because the federal government doesn’t tax it as income. But when you leave your employer because you are sick, you’re forced to purchase your own insurance when you need it most and can afford it least. A better solution is to allow states to impose a small premium tax on all group insurance that would subsidize above-average-cost patients forced into the individual market. Employers could avoid the tax by helping their employees buy individually owned insurance – which travels from job to job (like an IRA).

Healthcare is a complex issue not easily explained to voters. Republicans have better ideas but Democrats have better talking points that stress scare tactics over facts. If Republicans want to win over voters in the healthcare debate, they will have to be better communicators.