Our Progressive Vision: Every American should be able to get the health care they need, when they need it, at a price they can afford. But for years, insurance companies charged too much, their policies were full of holes, and coverage was easily denied or revoked. The Affordable Care Act changed that, providing families with a measure of health security. But there is still much to be done: (1) provide coverage to every American as a matter of right; (2) encourage healthy behavior and protect others from unhealthy behaviors; and (3) allow people to make their own health care choices.
Health care for all
Even though the Affordable Care Act has substantially lowered the number of uninsured Americans, at least 30 million people remain without health coverage. A progressive state or local government will do everything possible to assist and encourage people to take advantage of the ACA. Obviously, the first problem is the nearly two dozen states that have refused the ACA’s Medicaid expansion and thereby denied free health coverage to about 5 million people. But every jurisdiction can publicize ACA open enrollment, hold enrollment events, make information available through schools, libraries, and other government agencies, make sure that “navigators” and assisters are easily accessible to all, involve traditional insurance agents, and correct the misstatements that are keeping some from even considering enrollment. In addition, states and cities can expand their own programs to address chronic disease prevention and management, make oral health services more widely available, and support community health centers. “Healthy San Francisco” is a program that covers residents whether or not they are eligible for the ACA, such as providing coverage for unauthorized immigrants.
Encouraging healthy behavior
Preventable behaviors such as tobacco use, poor diet and physical inactivity, and alcohol or other drug use are the underlying cause of half of deaths in the United States, according to a recent study. A progressive government encourages healthy behaviors while leaving ultimate decisions to the individual. The biggest preventable killer remains tobacco, which claims more than 480,000 victims every year. Jurisdictions can discourage smoking by raising the tobacco tax, implementing workplace smoking and e-cigarette bans, and offering smoking cessation programs. States, localities and school boards can improve nutrition and physical fitness programs available in schools and also increase opportunities for athletics, walking and biking in communities. States and localities can raise alcohol taxes, crack down on sales to minors, and rethink whether their drug laws and enforcement systems are an efficient way to discourage the use of dangerous drugs.
Helping people make their own health care choices
Too often, people who are sick or dying are not given choices that should be theirs to make. If a doctor thinks that a patient with glaucoma, multiple sclerosis, nausea from chemotherapy or chronic pain would benefit from medical marijuana, the patient should have that choice. If patients would benefit from palliative care, they should be told. And if a terminally ill person wants to have some control over the time of his or her own death, that should be their decision, not the government's.
E-cigarettes are battery-powered devices that mimic cigarettes. A heating element vaporizes a nicotine liquid, which is inhaled by the user. Both the benefits and risks of e-cigarettes are rather uncertain, but nicotine is certainly an addictive substance and some teenagers who were otherwise nonsmokers are using e-cigarettes. There are two major policy issues at the state and local levels: whether workplace smoking bans should apply to e-cigarettes and whether marketing toward and sale to minors should be prohibited. Eight states and more than 500 localities have specifically forbidden e-cigarettes where smoking is already banned, in part because their safety is not established and because their use causes public confusion as to where smoking is allowed. Forty-six states outlaw the sale of e-cigarettes to minors.
End-of-life palliative care
All too often, terminally ill people are not provided adequate information about their physical condition or counseling about palliative care and end-of-life options. Too often they feel abandoned by the healthcare system and suffer unnecessary physical or psychological pain. People have a right to know when treatments offer only a tiny chance of prolonging their lives for a few weeks or months. And they have a right to know about palliative therapies which could make them feel a lot better for their remaining time. A few states now require healthcare providers to address the needs of the terminally ill. In New York, for example, when a disease is terminal and patients are unlikely to survive six months, doctors must inform them of this, and advise them of available medicines and treatments that comfort rather than cure. Palliative treatment can ease anxiety and pain, and can be administered at home, a hospice, or a specialized hospital unit. A good law also encourages the creation of interdisciplinary palliative care teams to provide medical, spiritual, psychological and practical support to patients and their families. And just incidentally, by eliminating medical procedures that patients don’t want, it also saves many millions of dollars.
Promote lower costs for prescription drugs
While the inflation rate was less than one percent in 2015, drug prices climbed by more than ten percent. Prescription drug costs are the fastest-growing component of health care in many jurisdictions. A new law in Vermont requires drug companies to justify the most egregious Rx price increases. Companies must disclose which of the most frequently prescribed drugs have the greatest price increases and the state attorney general is directed to determine the reasons for those increases, ultimately making the information public.