Health care will be a central issue in the 2020 presidential election. Even with improvements brought about by the Affordable Care Act, millions remain uninsured. Others find that premiums, deductibles and co-pays have skyrocketed. Many medical services such as dental care, hearing aids and long-term care remain uncovered by insurance plans. Medical costs have not been contained. Negotiation for reduced drug costs has not been accomplished. Health care and pharmaceutical lobbyists continue to control policy decisions. There are many things that need to be fixed.

Some candidates will propose incremental improvements and others will suggest revolutionary reforms. Not everyone agrees on whether affordable health care is a guaranteed right for all Americans, but most seem to agree that cost containment measures and improvements in continuity of care would be good.

Nothing significant is likely to change unless politics in Washington, D.C., change significantly. The presidency is only one piece of policy change. It is important to find out what all candidates — state and federal — think and what their health care values are.

Republicans have chanted “repeal and replace” ever since the ACA took effect. Republican candidates should be asked whether they still believe “repeal and replace” is best. If so, what are the details of their replacement plan? What are the cost projections? Do they believe in universal coverage for all Americans? What are they doing to reduce costs?

In his reelection campaign launch, President Donald Trump claimed that he will reveal a comprehensive plan by the end of summer. He has not killed the ACA as he promised, and it has not destroyed the economy as he predicted. He says that his plan will be much better and a less expensive alternative to “Obamacare,” but we await the details.

Democrats are proposing a variety of changes. Propaganda against Democratic ideas is already torrential with threats of “socialized medicine” filling the airwaves, social media and newsprint.

The AARP Bulletin from June 2019 summarizes the Democrats’ proposals in three categories:

• Single-payer plans: Medicare for All, a model for universal coverage, is an example. Our entire health insurance system, including the private insurance industry, would be replaced with a government-managed payment plan. Everyone would have coverage. Just like current Medicare for seniors, government would not be delivering health care but would be the insurer.

Other versions of single-payer plans could be more like the model of Great Britain. Government would have more hands-on management of health care delivery as well as being the payment source. (Despite popular horror stories, I have talked to people who use this system, and they have expressed general satisfaction and have pointed out its superiority to health care delivery in the United States.)

In both of these single-payer varieties, higher taxes would replace premiums, co-pays, deductibles and other out-of-pocket costs. Some might pay more, some much less. All Americans would be covered. And single-payer plans could allow for coverage of things such as dental care, hearing, vision services and long-term care that many insurers do not currently cover. Medicare Advantage plans would most likely go away.

• Medicare buy-in: This would leave the insurance market as it is. People could keep their private insurance if they wanted, but younger people could buy in to Medicare. Details about costs — both to individuals and to the government — need to be determined. Coverage would probably remain the same. And individual responsibilities for supplemental insurance to cover the portion of medical bills not paid by traditional Medicare (currently 20%) or for services such as long-term care would continue. The status of Medicare Advantage plans would need to be determined.

• Some version of the public option that was originally part of the ACA: In a compromise to get the ACA passed, the public option was removed to protect private insurers. This proposal would create a government-sponsored insurance with lower costs. The private market would stay in place, but people who cannot afford or cannot qualify for private insurance could get coverage through the public option. Having this alternative could increase competition and help to lower costs of premiums for everyone. Details about what medical services would be covered and how much the government would have to supplement a public option need to be disclosed.

Sorting through the promises of 2020 candidates requires reliable information about proposed changes.

Voters will need to ignore sound bites, decipher campaign jargon and examine candidates’ values regarding health care to determine which policy proposals best meet our needs.

And we should keep in mind that no candidate can effect health care improvements single-handedly. We must elect people at every level who will have the expertise and courage to fix some of our health care problems.

Sherry Buchanan lives in Joplin.