Commentary: What GOP, Democrats don’t get about health care

By Jan Radoslovich

For The Herald

I’ve spent more than 40 years working in the “guts” of our health care system.

I started as a bedside nurse, then turned to educating, and ended my career as a clinical informatics manager, leading a team of nurses who collaborated with our information technology department to install and maintain an enterprise-wide electronic health record system. I retired in August 2018 and am a current enrollee in Medicare.

As a progressive, I support policies that continue to expand access to affordable health care. As a nurse and Medicare recipient, I’m for focusing on what actually works. I know from my years of experience in the health care system that you can’t get the former if you don’t focus on the latter.

Today, I’m deeply frustrated by our national health care debate. The Republican Party is fixated on undoing the real gains made possible by implementation of the Affordable Care Act, also known as Obamacare. The Democratic Party, in turn, is polarized between a Medicare for All proposal that would shrink market and profit opportunities of private insurance companies and a hybrid system that combines private insurance with Medicare for those who want it.

Both parties need to refocus their ideological energy on how to provide insurance to the tens of millions of Americans who are still without coverage, expand on what’s working, and fix what’s not.

The Affordable Care Act made a number of very important changes to how people are able to get access to health insurance, banning claim denials based on pre-existing conditions, ensuring young people can stay on their parents’ plans until age 26, and rejecting lifetime limits on medical spending, among other things.

As matters of policy, these provisions are incredibly popular, and rightfully so. Before the ACA, patients were on the hook personally for out-of-pocket liabilities just as they were at their sickest and most vulnerable. We still have more to do, but the system we have now is a vast improvement over the one we had pre-ACA.

As a Democrat, I’m disappointed that we are not exposing the Republican position for the cynicism and backtracking it represents and are instead creating artificial divisions in our own party where they don’t need to exist. Advancing sound health care policy should be Democrats’ greatest electoral asset going into 2020, but I fear it may become our greatest electoral liability.

The reality of Medicare is that it operates as a patchwork of public and privately funded insurance options, payment systems, and plan requirements. This isn’t unusual, by the way; most countries with publicly funded systems — such as Canada — also have privately funded elements to account for health care needs unmet by the public system. The main policy ideas propelling the “Medicare for All” initiative fundamentally misunderstand this.

There’s also a functional reason for this balance between public and private funding. Any hospital’s chief financial officer will tell you that Medicare pays lower reimbursement rates than private payers. Clinical providers, especially in rural areas, struggle to find the right balance between publicly and privately funded patients so they can make payroll and keep their doors open. Lowering benefit options and reimbursement rates downwards may save the system money, sure, but will also result in barriers to care and could limit treatment options.

The system we have now may not be the one we would draw up on a white board if given the chance, but this is not an academic exercise. This is about people’s lives and well-being, not who has the best sound bite. Right now, the main health care policy proposals of both parties seem designed for their respective voting bases rather than expanding on what actually works.

Good policy makes good politics; in both regards, let’s focus on supporting and enhancing proven solutions in our health care insurance system. Too many patients have too much at stake to risk access to care to achieve ideological ends.

Jan Radoslovich, a registered nurse with a master’s in nursing, retired from the University of Washington’s Northwest Hospital and Medical Center in Seattle.