LEBANON — When Democratic presidential candidates spent a large part of their debate earlier this month talking about competing approaches to health care, it was a discussion Lebanon Diner co-owner Karen Liot Hill was pleased to hear.
“At least they’re trying to solve the problem,” said Liot Hill, who also serves on the Lebanon City Council and is thus far neutral in the primary. “This is an issue that hits home for families and businesses. They’re speaking my language.”
Liot Hill is 41 and has gone without health insurance for almost 10 years because she finds it unaffordable.
“I manage my health in a different way,” said Liot Hill, who grew up a Republican but became involved in Democratic politics during former Vermont Gov. Howard Dean’s 2004 run for president.
When health care needs come up, she pays out of pocket and often turns to urgent care clinics.
“Most of all, I’m incredibly lucky that we are healthy,” said Liot Hill, whose older daughter has coverage through her college plan and whose younger daughter is covered by Medicaid.
New Hampshire voters seem to agree that the current health care system needs fixing, with a good number thinking they’d like to move to a single-payer system of some kind, but they’re not in agreement about how to get there and how fast.
Some like the Medicare for All proposal being touted by Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., while others would prefer a more moderate approach, such as those espoused by Sens. Amy Klobuchar, D-Minn.; Kamala Harris, D-Calif.; and South Bend, Ind., Mayor Pete Buttigieg. These more moderate proposals would offer a public option by expanding Medicare or Medicaid, but they would also allow private insurance plans to continue.
President Donald Trump has based his health care policy largely around his campaign promise to repeal the Obama-era Affordable Care Act and replace it with “something terrific,” which Trump has yet to fully explain but that analysts largely interpret as increased emphasis on private insurance.
Given Trump’s previous failed push to repeal the law when Republicans had a congressional majority, much of the political chatter this election cycle has been about Democratic proposals with more clarity and more drastic reform.
The applies to Dr. Ken Dolkart, a 65-year-old semi-retired internist who currently is co-teaching an Osher@Dartmouth class titled “An Ailing Healthcare System: Where We Are, How We Got Here, Where We Need to Go” this fall.
“All of these (Democratic) plans are reflecting efforts to have genuine and comprehensive reform,” said Dolkart, who lives in Grantham. “All of them are better than what we have now,” he added.
Though Dolkart said he “loves Bernie” and the way Sanders has shaped the conversation about health care, he thinks Warren might be more effective right now. He also said he likes Harris, from a “political point of view.”
He does not, however, like former Vice President Joe Biden’s health care plan, which aims to tweak the Affordable Care Act, which became law during Biden’s time as vice president under President Barack Obama.
“I think Biden is too locked-in to his prior life and prior decades,” Dolkart said. “America is ready to move beyond that.”
Nationally, about 53% of Americans are in favor of Medicare for All, according to polling by the Kaiser Family Foundation. Support is broader, ranging from 74% to 77%, however, for other proposals such as optional Medicare for All, a Medicaid buy-in or a Medicare buy-in for ages 50-64, according to the foundation.
The downside of the more moderate proposals is that they may not be able to achieve the administrative cost savings that a Medicare for All, single-payer system could, and they also likely would fail to attract enough people to adequately share the risk, said Dr. Bradley Truax, of Grantham, who is co-teaching the Osher course with Dolkart.
He also said a smaller group wouldn’t have the clout that Medicare could in negotiating on prices with pharmaceutical companies, which is something that Medicare cannot do currently but the Democratic candidates all agree that it should.
“I like Bernie’s plan the best,” said Truax, a 70-year-old retired neurologist-turned-hospital administrator who continues to write a weekly column on patient safety. “His is the one that has been the most researched.”
Sanders’ plan would bar insurers and employers from offering coverage for benefits provided by the government-run plan, which would be funded by taxes on the wealthy, corporations and employers.
Though he supported Sanders last time around, Truax said he wasn’t sure whom he’d support this time. Though health care is an important issue, there are others that will inform his vote, he said.
“I’m not sure he’s the one who can actually beat Trump,” Truax said.
He noted that Warren “has most of the same platform ideas as Bernie,” but appears “much more electable.”
But Johanna Evans, a 31-year-old Lebanon resident who worked as campaign manager for former state Sen. David Pierce, D-Lebanon, said she thinks it’s time for the party to move past the electability issue. Getting past that, she said, will help the party to focus on whose policies are best.
So far, Evans has been volunteering with the Harris campaign and has met with staffers for New Jersey Sen. Cory Booker.
She said she likes that Harris’ ambition seems well-matched to her abilities and that she’s a “good, no-nonsense kind of person.”
Harris, according to her website, supports an immediate Medicare buy-in and a longer-term Medicare for All that would allow private health care plans to persist, while Sanders and Warren’s plan would get rid of them.
While Evans, who works as the film programming manager for the Hopkins Center for the Arts at Dartmouth College, said she leans left and would like to see Warren’s policy proposals enacted, she’s not sure the politics are right for it.
“I’m trying to be realistic,” she said.
Evans said she’d like everyone to have basic access to health care, but thinks that people also should have access to additional coverage based on their lifestyles and needs. For example, she said, athletes might have greater needs for orthopedic services than the average person, and they should be able to get the care they need to continue those pursuits.
“Completely abolishing private insurance doesn’t make sense,” Evans said. Americans “don’t all have the same health care needs.”
While she wasn’t sure which candidate she would end up supporting in the primary, Evans someone in the middle such as Harris or Booker is “where we want the party to end up.”
But Don Kollisch, a semi-retired family medicine doctor who has been involved with the Granite State chapter of Physicians for a National Health Program since 1987, said the moderates’ plans that would offer a public option of some sort, but allow those who wish to keep their insurance plans to do so are “misleading the public.”
“My organization does not support any candidate,” said Kollisch, a 68-year-old Hanover resident.
However, the group does support those who are in favor of Medicare for All, “where ‘all’ means everybody.”
That’s the only way, Kollisch said, to achieve “true equity” and “true savings.”
Right now, Kollisch said the candidates in this category appear to be Sanders and Warren, although Harris at one point expressed support for the proposal, she later walked that back.
Laurie Harding, a former state representative from Lebanon, said she thinks the ultimate goal should be moving to a single-payer system.
“I’m looking at the candidates very carefully to see who’s got that as a goal but who in fact is going to be very thoughtful and deliberate about the steps to get us there,” she said.
Though she was non-committal, Harding said she is “looking very closely at Amy Klobuchar because I like her approach to difficult issues.”
“She’s got a progressive vision, but is really very thoughtful,” said Harding, who is co-director of the Upper Valley Community Nursing Project, which helps seniors receive the care they need to stay at home.
Klobuchar has said that getting rid of private insurance would be a “bad idea.”
Eric Bunge, a 58-year-old from Etna, said he also likes the Minnesota senator. Bunge, special projects manager at Northern Stage who also consults with other art organizations in the region, is originally from Minnesota.
While he acknowledged that their shared roots might bias him, he said, “She doesn’t get the kind of press that I think her record, intelligence, willingness to work across the divide warrants.”
Bunge, who, along with his wife, Gayle, is forgoing traditional health insurance because purchasing it on the health care exchange established under the Affordable Care Act is too expensive, said he’s “a little bit leery” of Medicare for All.
“What does that mean?” he said. “Would there be unintentional consequences of health care skyrocketing? Should the government really be paying for all of these things?”
Like Bunge, West Lebanon Feed & Supply owner Curt Jacques is worried about the government getting more involved in health care. While Jacques, a registered Republican, sees that the status quo isn’t working well for his business or his employees, he doesn’t support a wholesale shift in the system.
“I think that we need to do baby steps on health care,” said Jacques, a 62-year-old Lebanon resident.
West Lebanon Feed & Supply offers employees a high deductible health insurance plan and then helps cover employees’ premiums and deductibles to a degree that’s based on their length of service.
It’s “still a burden for us,” he said.
Jacques, who did not vote for a presidential candidate in 2016 and said he likely will register as an independent before 2020, would support efforts to get pharmaceutical costs under control. He’d also like to see a wellness program that would teach people to “eat better, live better (and) be more smart about your own health,” he said.
But none of the plans proposed by the Democrats appeal to him.
“I’m afraid that more government means more money (and) more regulation (that will) slow the process down,” he said.
Nationally, some pushback for Medicare for All proposals has come from unions that have worked to negotiate health insurance benefits from their employers. But Mascoma Valley Regional High School industrial arts teacher Dave Shinnlinger, who is a member of the National Education Association in New Hampshire but does not currently hold a leadership position there, said he wasn’t turned off by any potential personal impact of a single-payer system.
“Anything that provides more access to health care for my students, their families, and our community is a good thing,” Shinnlinger said in an email. “Health care for all is an idea I’m willing to sacrifice some personal benefits for if it comes to that, but I am optimistic that we would all benefit from nationwide health care.”
He said he checked with leaders at the teachers union and they don’t currently have a position on the issue. Megan Tuttle, president of the New Hampshire arm of the National Education Association, did not respond to an email seeking comment.
Despite the fact that Liot Hill, the Lebanon city councilor, is one of the about 27 million Americans still without health insurance, she said her vote is up for grabs. She likes what she’s hearing from Warren, Buttigieg, Booker, Harris and Biden.
“I’m not a single-issue voter,” Liot Hill said. “There are so many issues — from the climate, expanding the promise of the American dream to everyone regardless of what they look like or who they love or where they live.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
