Hi, Bulwark readers! A few weeks ago I wrote about a health care proposal from the Center for American Progress. And as I said at the time, one reason to pay attention is that Democrats and their supporters are starting to have a conversation about what kind of policies they want to enact if/when they get the ability to pass major legislation again. The proposals getting floated today might become laws tomorrow. Now we have another proposal. It’s from the Searchlight Institute, and they have given me an early look at it. Today’s edition of The Breakdown explains what they have in mind, along with its potential pros and cons. I’ve tried to hold back from opining too much, because right now I think job number one is airing out these ideas so they can get the attention and scrutiny they deserve. Serving as a forum for good faith policy debates is a big part of what we seek to do here at The Bulwark, and why the support of our Bulwark+ members is so important. Would you consider joining today at the steeply discounted rate we’re offering this week? New members can get a year of Bulwark+ for half price: –Jonathan Exclusive: Read the Newest Health Care Proposal Being Circulated Among DemsA think tank that is trying to elect more unorthodox candidates is urging them to target private equity.A PROMINENT, DEMOCRATIC-ALLIED THINK TANK is releasing a new report on how to make health care more affordable, and it targets for-profit companies in a way that says a lot about how the politics of the issue are shifting. The report comes from the Searchlight Institute, which sees itself as a source of ideas that can deliver progress while appealing to voters who might not identify as progressive or liberal. But the report’s core recommendations seem perfectly compatible with the priorities of progressives. They include blocking the formation of hospital monopolies, limiting the role of private equity in health care, and stopping insurance companies from denying coverage arbitrarily.¹ It’s easy to imagine somebody like Bernie Sanders or AOC embracing these kinds of policies—and using some of the same language Searchlight leaders are invoking as they pitch their plan. “I think people are tired of being jerked around by big corporations that don’t have their interests at heart,” David Bowen, a Searchlight senior fellow and principal author of the report, told me in an interview. The report lands in the middle of a broad conversation now taking place among Democrats and their advisers, in the hopes of forging some kind of consensus on health care reform so they are ready to act whenever the political opportunity presents itself. The Searchlight report, which the organization planned to publish and circulate Tuesday evening, will actually be the second one the group has issued this month. The first came out a little less than two weeks ago, when the organization formally called for free primary care. The month prior, the left-leaning Center for American Progress published a health care agenda that included a call to regulate hospital prices. And that’s on top of the more ambitious overhauls that many Democrats have been floating for years, like progressive proposals for a “Medicare for All” system, that very much remain part of the debate. But the CAP and Searchlight proposals are notable because of those groups’ many ties to party leaders. And although the plans are different in their particulars and in their framing, both focus on the ways hospital monopolies have raised prices, just as both seek to curb the power of insurance companies to deny treatments. The common element here is the contempt for corporations and conglomerates who seem to be putting shareholder profits before the best interests of their patients. There are good reasons both groups have landed there, and those reasons start with all the evidence that for-profit health care companies really are having some pernicious effects. ONE OF THE BIGGEST HEALTH CARE SCANDALS in recent history was about a private equity firm that started acquiring hospitals in 2010, and within a few years had created the largest for-profit hospital chain in America. It was called Steward Health Care. The original idea had been to rescue some nonprofit hospitals that had been struggling financially by bringing in smarter management and finding economic efficiencies. But Steward racked up billions of dollars in debt. By 2024, it was beset by widespread reports that it was not paying its bills, forcing the closure of some facilities while leaving others short of staff and crucial supplies. Among the unsettling stories that journalistic and government investigations eventually produced was an allegation—which Steward strenuously denied—that supply issues had led directly to the death of a Massachusetts woman after childbirth. Doctors had wanted to perform a procedure to stop bleeding in her liver, according to reporting in the Boston Globe, but staff said they were unable to do so because a supplier had repossessed the required equipment. Steward would go on to declare bankruptcy, and there’s still ongoing litigation involving various parties associated with the company. But things worked out okay for the private equity firm and its shareholders, who together made hundreds of millions of dollars. The Steward story is an extreme example of what is now a well-chronicled phenomenon: Private equity gobbling up hospitals, physician practices, nursing homes, and other providers to build giant health systems. The promise is always the same: that the integration and consolidation will yield efficiencies. And |