American Political Theatre: Act Two—The Democratic Convention

73 speeches and a week later, it’s time for the second act of the American political theatrical, the Democratic National Convention in Philadelphia this week.

Last week, little was said by the GOP about healthcare. In their nominee’s 76-minute acceptance speech Thursday, a pledge to repeal Obamacare the sole reference. For the first time in 36 years, the party’s standard bearer did not affirm his opposition to abortion and said nothing about Medicare.

In the GOP’s platform, approved by its 1472 delegates, there’s more, including a promise to repeal and replace Obamacare, a resolve to change transition Medicare to a defined contribution plan and raise its eligibility threshold to 67, improvements in Veteran’s Health, block-granting Medicaid to states and more.

The GOP theme last week was “Making America Great Again.” The Dem’s this week, is “Stronger Together.” It’s Act Two of the continuing series of Campaign 2016.

In all likelihood, we’ll hear more about healthcare this week than we did last. That’s understandable. Healthcare has been a prominent issue among Democrats for decades dating back to FDR’s New Deal and Lyndon Johnson’s Great Society programs, and more recently, the passage of the Affordable Care Act (March, 2010) by the Obama administration.

Among Democratic primary voters this season, healthcare was one of three issues alongside jobs and national security that drew voter attention. In their vigorous primary dual, two contrasting views about healthcare emerged: the Sanders campaign pushed universal coverage and a bigger role for the federal government; the Clinton campaign called for repairs to the Affordable Care Act and expanded coverage for several at-risk groups. Both vowed to rein in drug prices, protection of abortion rights and veteran’s health improvements.

In advance of this week’s festivities, the White House weighed in on healthcare via the President’s 5000-word essay in the Journal of the American Medical Association (JAMA). He laid out the accomplishments of the Affordable Care Act and the need for expanded coverage via the public option. And at the end of last week, the DNC released its platform wherein healthcare is a prominent theme in its domestic-policy heavy strategy for governing. National defense and foreign affairs occupy less than in the 55-page document.

In its platform, the Democratic Party is doubling-down on the Affordable Care Act in Campaign 2016, expanding access and health programs paid for by higher taxes on the wealthy.  The platform commits more funding for and improvements in veteran’s health, treatment for HIV, autism, mental health, addiction, long-term care, Indian and rural health, community health centers and cutting edge medical research. It calls for employers to grant medical leave and expands programs for the disabled. It assails greed and price gouging by drug makers promising to capping what Americans are required to pay for their prescriptions, ending the industry’s “pay to delay” deals that keep generics off the market and allowing importation of drugs from Canada and other countries. Noticeably, the DNC platform has little to say about health insurers save references to the need for affordable coverage.

But perhaps the strongest declaration in the DNC platform is its core belief that healthcare is universal right: “… Democrats will never falter in our generations-long fight to guarantee health care as a fundamental right for every American. As part of that guarantee, Americans should be able to access public coverage through a public option.”

That Democrats see healthcare as a fundamental right with a larger role for the federal government is in stark contrast to the GOP preference for a market driven approach with more responsibility borne by states. Healthcare as a universal right is not a new idea: polling by Pew, Kaiser and others indicate it resonates with the majority of Millennials and those in middle and lower income cohorts who see the system as a complicated money machine and healthcare as a basic right. But it’s highly controversial, especially among voters who dubious about too much government control and many who believe entitlement programs institutionalize inefficiencies that the private sector can handle better.

The DNC platform links social unrest, economic disparity, shortages in primary and preventive health, and lapses in mental health as complicating factors in an inadequate health system: “We will tackle the problems that remain in our health care system, including cracking down on runaway prescription drug prices and addressing mental health with the same seriousness that we treat physical health. … We will fight Republican efforts to roll back the clock on women’s health and reproductive rights, and stand up for Planned Parenthood.…And we will tackle the epidemics of substance abuse and gun violence, which each claim tens of thousands of lives every year.”

Both the GOP and DNC platform documents are platitudinal by design: they reflect the direction they wish to take the country if chosen to govern. As Campaign 2016 transitions from the testy primary care season to the main event, both sides will posture themselves toward independents and the politically disaffected hoping to win in the fall. Democrats are betting healthcare will be a winning issue for their ticket.

The 10 news networks combined drew 32 million to Thursday night’s closing session of the GOP convention, on par with the 2012 audiences but 6,000,000 fewer than coverage of 2008 RNC coverage that featured Mitt Romney as the party’s standard-bearer. Behind the scenes, the GOP has a few sticky issues to resolve led by how to rationalize their candidate’s promise to leave Medicare alone versus Speaker Ryan’s and the platform plan to use premium support as its structural reform.

Now the attention turns to the Clinton-Kaine ticket, with Ms. Clinton’s remarks this Thursday highlighting the party’s run for White House. Healthcare will be prominent in their positioning: three of the four nights will be devoted to domestic issues and viewers will be reminded that the Affordable Care Act is evidence that Democrats pay attention to healthcare.

As a student of healthcare policy, the contrasts between the two party’s views on healthcare is classic: a bigger federal government role vs. reduced, repairs to the Affordable Care Act vs. repeal and start over, healthcare as a fundamental right vs. healthcare as a private industry, and so on.

I’d like to think journalists will nudge the parties and campaigns toward substantive discussion about the future of the healthcare system. I’d like to believe the campaigns are hard at work finding answers to the trickiest questions we face, like end of life care, social determinants of health, the balance of cutting costs and maintaining quality and safety and so on. I’d like to hear how expansion of the federal government via a public option might work, and whether hospitals and doctors could afford to participate or be allowed to opt out. I’d like to imagine the networks will stage at least one debate around healthcare, since it’s the biggest spend in the federal budget and prominent among voters. And I’d like to believe that after Act Two of the partisan infomercials in Philadelphia, healthcare will take center stage for the balance of Campaign 2016 where it deserves to be.

Stay tuned this week: you’ll hear more about healthcare than the week prior no doubt. Let’s hope it sparks voter appetite to hear more.

Paul