Republicans and Democrats are offering very different views on what America’s health care system should look like as the country heads into the 2020 election.

Exit polling showed that health care was the top issue on a plurality of voters’ minds heading into the 2018 midterm elections, NBC News reported.

Forty-one percent listed it as the issue most important to them, followed by immigration at 23 percent, the economy at 21 percent and gun policy at 11 percent.

Health care promises to be among voters’ top concerns going into 2020 as well, especially with prominent Democratic presidential candidates like Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts making “Medicare for All” a centerpiece of their candidacies.

Other Democratic candidates, like former Vice President Joe Biden and South Bend, Indiana Mayor Pete Buttigieg, have called for a public health insurance option.

On his website, Biden’s campaign describes the public option as being “like Medicare.”

Meanwhile, Buttigieg’s campaign has said he wants to achieve universal health coverage in the U.S. by making Medicare available to “all who want it.”

With a public option in the mix, the future of private insurance coverage in the country would be unclear, the Kaiser Family Foundation reported.

Depending on the structure of the public option, the impact would be to underprice and therefore undercut the private market.

GOP Rep. Debbie Lesko of Arizona, who is a signatory to the Republican Study Committee’s health care plan, told The Western Journal that the public options are “just a pathway to get to Medicare for All.”

“It just makes it sound better,” she said.

Critics of Medicare for All have noted the extremely high costs involved with the vast expansion of Medicare, which is already the nation’s second-most-costly entitlement program, only trailing Social Security.

Advertisement – story continues below

According to the Congressional Budget Office, approximately $582 billion went to pay for Medicare in 2018, while an additional $389 billion financed Medicaid, for a total of $971 billion in public health care spending, falling just $11 billion short of the Social Security total of $982 billion.

The entire federal budget in 2018 was $4.1 trillion.

Warren has estimated the cost of her plan to be $20.5 trillion over 10 years (more than $2 trillion per year), but an analysis by the Urban Institute places the figure at approximately $34 trillion.

Hadley Heath Manning, director of policy with the Independent Women’s Forum and a senior fellow with the Steamboat Institute, sees problems beyond just the costs with Medicare for All.

“My number one concern is how it will impact Americans’ access to health care and the quality of health care that we receive,” Manning told The Western Journal.

She pointed to Canada’s health care system as being most akin to what Sanders and Warren are proposing. Canada is notorious for having long wait times for medical care.

“I think it is a false promise that Americans will have equal access to high-quality health care under Medicare for All,” Manning said. “Medicare for All guarantees health coverage, but it doesn’t guarantee health care.”

She referenced the Republican Study Committee plan released earlier this year as offering some strong reforms that would improve the country’s health care system.

The policy expert highlighted the proposal to greatly expand the size and purpose of health savings accounts as particularly promising.

The RSC plan would expand tax-free dollars that employers and employees can contribute to HSAs from $3,500 to $9,000 for individuals and $7,000 to $18,000 for families.

This money can then be used to purchase health care plans individually, thereby decoupling health insurance coverage from being directly paid for by the employer.

This reform would make coverage portable, meaning when employees leave or lose their job, their health insurance can remain in place.

“You don’t have to rely on your employer and you can take your plan with you if you jump between employers,” Lesko said.

The change will also mean those with pre-existing conditions will be protected from a gap in coverage.

Additionally, the RSC proposal reforms the tax code so employer and individually purchased health care plans would receive the same tax-free benefit.

The overall goal is to introduce more market forces, and thereby lower costs without lowering the quality of care.

Lesko contended if Medicare for All were adopted, “Medicare as we know it would be gone. Medicare advantage would be gone and all the people that have employer plans would be gone.”

“All existing health insurance would be gone and just be replaced with this one-size-fits-all, government-controlled health care plan,” she added.

Both Manning and Lesko would like to see the health coverage function like other insurance plans, such as home and auto, which are in place to handle unanticipated costs.

“We don’t treat health insurance like insurance. Insurance is something that should be a backstop against financial costs, unexpected financial costs,” Manning said.

Under the Republican plan, annual checkups and other routine medical costs could be handled through health savings accounts or out of pocket.

The Trump administration has taken action at the executive level to implement market-based and other reforms into the health care system.

President Donald Trump announced last week two regulatory rule changes that make health care prices more transparent.

“We believe the American people have a right to know the price of services before they go to visit the doctor,” Trump said in a White House news release.

The first rule change requires hospitals to display prices for “shoppable services as a total package in an easy-to-read, consumer-friendly format.”

A second proposed rule makes “insurance companies and group health plans to provide cost estimates to enrollees in advance of care,” the news release said.

“Armed with accurate information, patients can shop around for healthcare services and make the decision that is best for them,” the White House said.

“By increasing price transparency and empowering patients we can help lower the cost of healthcare and drive competition.”

According to a Council of Economic Advisers paper put out by the White House, prescription drug prices are decreasing at rates not seen since the 1960s after increasing steadily throughout much of the Obama administration.

Market Watch reported in March that prescription drugs dropped 1.2 percent over the previous 12 months, which is the largest 12-month decrease since 1972.

The Trump administration credits a record-high approval of generic drugs by the Food and Drug Administration last year for helping create competition that puts a downward pressure on drug prices.

With 180 million Americans currently covered through private insurance, voters clearly face a major decision going into 2020: Medicare for All, public option, the status quo or market-based reforms.

How Americans choose clearly could have a profound impact on the health care received for decades to come.

The Western Journal reached out to Warren and Sanders for comment. We will update the story if and when they respond.