How to vote today like a pragmatic progressive

“You’re for Medicare for all,” one of my soul sisters stated as we sat across a café table in the heart of Harvard Square in Cambridge, Massachusetts. This lefty-liberal friend did not ask. She asserted. We were, after all, sipping lattes right there in Liz Warren’s neighborhood. 

“Well…” I tilted my head and shrugged one shoulder, conveying my reluctance to embrace a single-payer health care system fully. 

I usually feel right at home in this deep blue well of liberalism. It is my home for a reason. But at this moment, I felt like an unwelcome visitor, like someone who had arrived too early to a party or brought some food items to which the host is allergic. I felt a little like a traitor.

My progressive credentials are solid. I’ve canvassed for Hillary and Warren. I played hooky to hear Barack Obama speak at a campaign rally. I went to college at Brown — a haven for artsy, free-thinking types.  

My favorite vacation spot is Provincetown on Cape Cod, a liberal, gay mecca where all are welcome. I bought my 13-year old son a “Vote Blue No Matter Who” T-shirt there last summer – at his request. I must be doing something right.  

I also have an MBA and believe in the power of market forces. After nearly a decade as a health insurance executive, I spent two years researching consumer experiences making financial decisions in health care. I believe that Americans are most influential when we vote with our wallets.

As Super Tuesday approached, I started getting more and more questions about Medicare for All. As a die-hard liberal, why aren’t you all in?

The assumption behind this question is that there is only one way to stand up for consumer interests. I don’t see it that way.

Single-payer systems ensure universal insurance coverage and reduce direct financial burdens on beneficiaries. Private profit motives do not conflict with social aims. Governments — citizens must believe — have the public interest at heart, and the administrative capacity to manage these vital services efficiently and fairly.

But these systems are far from perfect, on paper or in reality. I traveled to Australia in 2013 to study their hybrid public-private system, underpinned by universal “Medicare” coverage. I heard more than once, “Why have you come here to study us?” Sure, they spend only 9 percent of GDP on health care – half what the U.S. spends — but to them, it seemed unsustainable (and it probably is). 

Colleagues and friends from countries with “pure” single-payer systems report atrocious access problems and, at times, questionable quality. They describe parallel private systems in which people with money jump the line. The same doctors may practice in both systems, and have greater financial incentive to practice privately. As doctors devote more time to more lucrative private-pay patients, access in the public system erodes. Anyone who can pay for private care has even more reason to do so. 

I see another way to advocate for consumers and improve access to affordable care — through the very financial incentives that have caused many of our system’s flaws.

Historically, consumers have been overlooked as financial stakeholders in the American health care system. Consumer-grade value, clarity, and service have not been priorities because patients have not been directly paying the bill. Prices have developed via convoluted negotiations between providers and health plans, without regard for the consumer.

But consumers now pay one-third of health care and coverage costs out of pocket, approximately $1 trillion per year. Americans spend almost as much each year at holiday time. To attract those dollars, retailers woo us with promotions, advertisements, sales, and extended hours. At Christmas time like no other, American consumers are king.

In health care, too, $1 trillion should entitle consumers to a say in how care and coverage are designed and delivered. For $1 trillion, consumers should get a wide array of insurance options to suit a diversity of preferences. We should get apparent, rational, fair price information — before we must commit to paying whatever it is. We should get information on treatment alternatives and value for our money. And we should get what we pay for; if treatment or surgery fails, should we still have to pay? 

If consumers treated health care spending in shopping terms, we could exert financial pressure on suppliers to meet our needs and priorities. The #GrabYourWallet movement organized consumer boycotts of companies doing business with the Trumps; it worked. Nike’s sales and stock performance improved after running its Colin Kaepernick ad; despite some calls for Nike boycotts, consumers rewarded their support for Kaepernick’s stand against police brutality. Walmart’s stock rose on the news they would curtail gun and ammunition sales in the wake of mass shootings. 

Health care organizations and corporations that do business with them could similarly respect and respond to consumer preferences. They could set and publish clear and rational prices, openly and proactively discuss costs with patients, provide alternatives, and deliver real financial value.

And consumers could reward health care businesses who get these things right. Voting with our wallets in health care is not as simple as buying branded sneakers like in the Nike case. But, it may not take as long as passing and implementing Medicare for All. It’s also something all consumers can take part in starting today.

If and when American society is ready to embrace and enact universal health coverage, I will be the first to cheer. But until that day, even progressives can embrace a market-driven movement — one in which consumers recognize and wield their power of the purse.

Deb Gordon is an Aspen Institute Health Innovators fellow and author of the forthcoming book The Health Care Consumer’s Manifesto: How to Get the Most for Your Money. Follow her on Twitter: @gordondeb.