By: Nick Bonds, Esq. Forgive me, but I want to take a minute to look at the politics of the health care debate. I know, the conversations around impeachment, gun control, immigration, and the 2020 election eat up a lot of the oxygen in the room. Plus, new evidence suggests that being politically engaged is a significant source of stress in our daily lives, and comes with its own emotional cost . Nonetheless, the discussion surrounding what path the American health care system should take is a fundamental concern to our industry, and it seems well worth taking a moment to examine the possibilities. A wide swath of 2020 Democratic candidates (e.g. Booker, Buttigieg, Castro, Gabbard, Harris, Sanders, Warren, Yang) support some version of Medicare-for-all, expanding the Medicaid to cover all Americans instead of just those 65 or older – effectively replacing the current health care system with a government-run single-payer system. Sanders and Warren seem willing to do away with private insurance altogether, while candidates like Yang and Buttigieg would keep private insurance around at least for a while. Another cohort of the candidates are in favor of a more incremental approach to improving the health care system, many through a public option (Bennet, Biden, Delaney, Klobuchar, O’Rourke). Their argument is that “Medicare-for-all-who-want-it” is more practical in the short term, and the most direct path toward Medicare-for-all in the long run. Biden in particular has been protective of Obamacare, going so far as to attack other Democrats for impugning President Obama’s legacy. His campaign team may also be looking at some of Obamacare’s poll numbers , which seem to show that an incremental approach is more popular with voters than eliminating private insurance entirely. Meanwhile, President Trump is making moves to campaign hard on his health care agenda. Tacking hard away from the Democrats, the President’s recent speech at The Villages retirement community in Florida announced his executive order to expand private Medicare Advantage plans. This is the latest in the administration’s effort to make the Republican Party the “party of health care,” including moves to increase drug importation, overhauling kidney care, increase price transparency, and his State of the Union promise to wipe out HIV. The Hill has not been idle either. Speaker Pelosi has unveiled a plan to allow Medicare to negotiate prices on as many as 250 drugs, including insulin, and apply those discounts to private health plans. Reining in prescription drug costs seems to be one of the few areas of common ground between the Speaker and the President, though with a formal impeachment inquiry underway teamwork between their camps can only become more difficult. Bipartisanship is still possible, however, as shown by the Health Savings for Families Act – a new law introduced in Congress designed to allow families to utilize HSAs and FSAs simultaneously. If Democrats from Virginia and Oregon can work with Republicans from Pennsylvania to draft legislation, maybe there is hope for us all. Between candidates’ policy proposals, legislative team-ups, executive orders, and the ever-churning news cycle, the political landscape of health care can seem harrowing. The tug-of-war in Washington is yanking our health care system in so many directions right now that at times it looks more like it is being drawn and quartered, and the political conversation is stressful enough that you would be forgiven for wanting to unplug for a while. But still, a change is gonna come. One of those ropes is going to snap or one team will land in the mud. Stay tuned to see who pulls hardest.