By MICHAEL MILLENSON
It’s close to an iron rule: Politics drives policy. In that context, the health policy issues that were largely invisible at the Republican and Democratic conventions taught a crucial political lesson.
Start with access. According to KFF (formerly the Kaiser Family Foundation), more than 25 million Americans have been disenrolled from Medicaid as of Aug. 23. Ten states, all dominated by Republican legislatures and/or governors, have declined to expand the program, leaving 2.8 million Americans unnecessarily uninsured.
Yet if you were looking to either convention to find protestors telling heart-rending personal stories to humanize those statistics, you’d search in vain. There were none.
The Poor People’s Army, a group advocating for economic justice, did invite reporters covering both conventions to focus on one of the most urgent issues facing the poor and near-poor – not medical care access, but the lack of basic housing.
Homelessness set a record in 2023, according to the National Alliance to End Homelessness, affecting one in 500 Americans, while the number of renters forced to pay more than 50 percent of their income has surged since 2015. The former is apparent on the streets of every big city, while the latter is felt by millions in every paycheck.
The political lesson is clear. While support for Medicaid expansion was buried deep in the Democratic platform, at the grassroots level there’s no sign of the kind of passionate involvement that could drive votes in a close election. Medicare, of course, is a separate issue, with both parties promising to protect the program dear to the hearts of the nation’s elderly, who have the highest percentage voting turnout of any age group.
Of course, even those with good health insurance often have to worry about medical costs, with KFF polling finding that a shocking 41% of U.S. adults have medical debt. However, although the phrase, “It’s the prices, stupid!” has become a bipartisan policy refrain, there are no swing state votes to be swung by harping on the alleged cupidity of the local hospital. So while denouncing “medical debt,” no one did.
On the other hand, Democrats spoke repeatedly about the depredations of “Big Pharma.” The GOP platform satisfied itself with a vague promise to “expand access to new…prescription drug options” to address prescription drug costs that “are out of control.” The responsibility for those prices was unspecified.
As for health insurers, articles about questionable denials of medical claims by giant insurers like United Healthcare and Humana have garnered headlines and expressions of outrage. Once again, however, the grassroots reaction is the key. There has been no outpouring of public indignation remotely comparable to the HMO backlash of the 1990s. As a result, health insurers have largely vacated the role of politically visible corporate villain.
A political campaign, as former President Bill Clinton pointed out in his speech to the Democratic convention, is a job interview with the American people. As with any job interview, the total focus is on getting the job offer, knowing that if you do, much is possible, but if you don’t, nothing is. That means carefully calibrating every utterance during the interview process in order to make a favorable impression, while avoiding – making invisible – anything that might jinx your chances, even if it’s a topic about which you’ve already expressed a firm opinion. (See: GOP on abortion and same-sex marriage or Democrats on Medicare for All.)
The allure of potential political power is what produces a second kind of invisibility with often the greatest impact on policy. That’s the invisibility of the big donors and well-heeled lobbyists. They’re not in the TV shots of the convention floor. They wore no colorful costumes or big buttons. Instead, they discretely gathered at the hotels hosting delegates and mingled at the private parties that draw influential policymakers. All the while they practiced the invisible influence peddling that, behind closed doors, can help make or break a policy proposal.
To preserve access to “the room where it happens,” corporations carefully contribute to both parties and to both parties’ individual candidates. One typical example is the list of contributions from UnitedHealth Group, a company that ranks fourth in size in the Fortune 500 list behind only Walmart, Amazon and Apple.
In the 2024 election cycle UnitedHealth and its affiliates have given $151,343 to Kamala Harris and $57,491 to Donald Trump, according to the latest report by OpenSecrets. There was also roughly $329,000 donated to various Republican campaign committees, and another $200,000 to a Political Action Committee supporting Nikki Haley’s GOP primary run. The various Democratic campaign committees received about $149,000. That’s on top of the $10.76 million spent in 2023 on lobbying, says OpenSecrets.
None of this, of course, was mentioned from the speaker’s podium at either convention. Instead, we heard repeated claims to represent the “middle class,” a self-identified group that makes up the majority (54%) of the U.S. population. This group, essential to elective success, is thought to care little about Medicaid and see MedicareAdvantage as a health insurance choice filled with freebies. They don’t want to talk about the 232,000 Americans who died because they didn’t get a Covid vaccine, and “climate change” is a topic that appeals mostly to those who are already Democrats. What they do care about is cost, cost, cost.
If you were among those frustrated by the political invisibility of the host of pressing health care problems crying out to be addressed, there is a solution: Start your own PAC.
As author, activist, consultant and a former Pulitzer-nominated journalist, Michael Millenson focuses professionally on making health care safer, better and more patient-centered. This piece first appeared in his column in Forbes
