I am feeling really nostalgic for the good old days of 2009.
Remember when Ashton Kutcher and Snooki were the biggest names on Twitter? Before Kanye was Yeezy and LeBron was a pre-“decision” Cavalier?
In those good old days of yore, the United States was engulfed in a serious conversation about the future of health care. Every other week we were inundated with grainy Blair Witch Project–looking videos of town halls where angry Americans claimed Obamacare was going to drive up prices and kill capitalism. Republicans were scared, Democrats were scared—but at least the country was talking about health care.
It would be great if we returned to those days of passionate debate, because there is another health care crisis on the horizon, that if not confronted soon, we’ll all be taking out a second mortgage for a bottle of aspirin.
The Affordable Care Act (ACA) had two main stated goals: the first was to increase the number of Americans who have some form of health coverage and the second was to make health care more affordable. The first goal has been accomplished. While there are caveats, most private analyses show about 16 million Americans have gained health care coverage through the ACA. Most of these people are poor, under 30 and minorities. However, on the cost end, the ACA has driven up costs for millions of Americans, which has a disproportionate impact on minority communities especially when it comes to pharmaceuticals.
Where is the problem starting? With a little known middle man known as the pharmacy benefits manager (PBM).
In theory PBMs (as they’re called) are like in-house pharmacists at your job. They negotiate deals with drug companies and your health care provider to help employees, whether they’re public school teachers or IT professionals, get a better deal. In theory. What’s actually been happening, though, is these folks have been taking kick-backs from drug companies, picking and choosing which employees get the best drug choices, and basically destabilizing a system that was supposed to help everyone.
This new layer of health care management is particularly tough on African-American consumers, many of whom live in pharmacy deserts where their options for drug assistance, care and advice is limited. In other words, seven years later, the Affordable Care Act has empowered insurance providers and middle management over consumers and neither the presumptive Democratic or Republican nominee has really suggested what to do about it.
Hillary Clinton and Bernie Sanders provided some semblance of a health care debate during their primary but it was pretty reductionist. Sanders wanted to improve some of the price control options in the ACA and Clinton claimed that he wanted to scrap the entire policy. Which is the equivalent of saying if you want to adjust the thermostat in your house you’re just angling to buy a new house. It was petty politics at its finest as Clinton tried to portray herself as the defender of President Obama’s greatest policy legacy. It was at least a discussion, though—a nuanced discussion that the GOP refuses to have.
The Republican primary debates didn’t discuss many health care reforms other than candidates crawling over themselves about how much more aggressive they’d be in repealing “Obamacare.” I think Ted Cruz won by saying he would literally eat the thousand-page policy on national television then spit it out before setting it on fire. The point is, America didn’t get much of a health care debate during the primaries and there is even less discussion now that we are in general election season.
In the meantime, Americans are seeing drug prices jump like gold stocks during the recession and no one is doing anything about it.
It may not be popular, it may not be the politically expedient thing to do, but someone running for office this year might have to broach the very bold and very controversial topic of reigning in the health insurance industry. With five (soon to be three) big companies dominating the insurance market and leaving ACA exchanges every other day, this situation is getting out of control and it deserves to be laid bare on the national stage. Maybe this will lead to crazy town halls again or violent arguments at the Republican and Democratic conventions, but so be it. About 50 percent of Americans have given Hillary Clinton a pass on her various corruption scandals and about 40 percent of Americans have given Donald Trump a pass on his incompetence and bigotry.
We should at least hold them accountable for pitching some ideas on how to fix our health care mess given the other candidate weaknesses we’ve had to swallow.
At this point, it’s not just health care but politics that’s making too many of us sick.
This article originally appeared online at The Root.