Standing in the aftermath of the second Republican Presidential debate, we as Americans now recognize that Presidential campaign season has officially begun. We also are in the wake of the controversial passage and rocky implementation of the Affordable Care Act—popularly known as Obamacare—and we will now hold our first national election in which the law’s advocate-in-chief will not be on the ballot. Republican and Democratic candidates alike will offer their perspectives on the law, its strengths, its weaknesses, and what should be done in response to them. As I talk with my friends in and out of medical school, several questions bubble to the surface: how should we as voters react when we hear candidates speak about Obamacare and their respective health plans? What would be helpful for us to remember in the midst of those conversations?
A few things will help us as citizens navigate these choppy campaign waters. First, do not expect a candidate to give a full plan with nuanced details during a speech, rally, or interview. Winning votes determines the success or failure of candidates, and therefore getting votes becomes the candidates’ ultimate focus. In order to do this, any candidate worth her or his salt simply must speak in language and ideas that as many voters as possible can understand.
While this political reality has the advantage of engaging many citizens regardless of background or education level in the political process, it has the inherent limitation of cutting short some of the more substantive policy discussions that many voters would like to see in a campaign. Health care is a great example of this. Health policy is a complicated field that candidates must boil down into digestible phrases we hear such as “repeal and replace Obamacare” or “universal health care.”
This leaves many voters wanting to know more. For example, repeal Obamacare and replace it with what exactly? What do you mean by universal health care? What is your plan?
For voters who find themselves asking these questions, a few things will be helpful to know. First, while every serious candidate will have a health policy proposal, the authors of those plans will be campaign advisors, not the candidates themselves. Many of these advisors are health policy scholars who work either in academia, at think tanks, or sometimes for the campaign itself. Whereas candidates spend their time trying to get votes, policymakers spend their careers focusing on ideas, such as the details of how to reform Medicare to make it more financially sustainable and improve reimbursement rates for health care providers. They write papers, publish studies, give speeches, and make friends with (prospective) candidates. When candidates make it to the point in the campaign where they need to offer a health policy proposal, they (and their campaign staffs) often turn to their friends and allies in the policy world.
If you really are interested in the details of a candidate’s plan, find out who is writing their health plan and then look at what that policy person has spent a career advocating. In the age of the Internet, any Google search will find you a list of publications, many of which will be electronic. Read those and read about the think tanks that employ or have employed those advisors. With a little research, you will gain a good understanding of some of the details in a plan and especially how the plan’s author thinks.
As you might imagine, in the same way that different candidates have different ideologies, different policymakers do, too. So Republican candidates turn to conservative health policy scholars and think tanks, and Democratic candidates look to progressive or liberal ones. For example, The Heritage Foundation (http://www.heritage.org) and American Enterprise Institute (https://www.aei.org) are both well-known conservative think tanks. The Center for American Progress (https://www.americanprogress.org) promotes progressive or liberal policies. Looking through publications on each of these sites will enable you to understand what types of policies a policymaker is likely to promote. It is important to remember that much of public policy is about priorities and means—what you want to achieve and how you plan to get there. As students training in health care fields, you will be able to use your clinical experiences to understand how you feel about whether a set of policy proposals will allow health care providers like you to provide better care to patients across the country.
Gaining a better understanding of a health policy advisor and her or his health policy preferences is critically important because any policy plan has to meet the political reality of governing. Plans can change as a candidate-turned-President looks at what she or he must put in a plan in order to get it passed by Congress. Many of the campaign advisors will remain advisors during the governing process, either formally or informally. These policy advisors will help Presidents navigate new political waters.
In summary, campaign season is here again, and many of us will want to know more about the health policy proposals of different candidates. In order to do this, focus not only on the candidate but also on the author of the candidate’s plan. Her or his track record along with her or his current and former employers are good markers for better understanding the thinking that will inform not only the candidate’s health policy proposal during campaign season but also the adjustments that she or he will need to make when confronted with the political realities of governing from the White House.
Jonathan Crowe is a second-year medical student in Augusta. His health care interests include caring for patients, health policy, global health, and medical technology innovation. When he is not at school, you can find him sleeping in, hunting for good barbeque, listening to music a little too loudly, spending time with friends, and loving most things either athletic or outdoors.
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