Conservatives and progressives agree that everyone should be able to get health insurance and have access to quality health care. But the divide over how to accomplish that goal is wide and deep.
Progressives believe the government should make decisions about the allocation of resources in our health sector, while conservatives believe these decisions should be controlled by individuals and families.
But then come the tradeoffs: Washington bureaucrats would decide what services are covered and how much doctors and hospitals would be paid. Also, everyone would be required to give up the coverage they have now - including 173 million Americans who get health insurance at work - and taxes would be much higher to finance $32 trillion in added government spending over the next decade. For comparison, federal revenues last year totaled $3.4 trillion.
"If you look at polling data, it's great until you tell them taxes would double and they'd have to give up their employer coverage," Sen. Bill Cassidy, R-La. noted.
The American people don't want such a major upheaval. They rightly don't trust politicians and their broken promises, such as former President Barack Obama's, "If you like your doctor, you can keep your doctor. If you like your health plan, you can keep your plan."
At least this time, they are being up front: They would outlaw private health insurance entirely.
California Sen. and Democratic presidential candidate Kamala Harris supports a government-run single payer system and said of private health insurance: "Let's eliminate all of that."
What they aren't saying this time is that "free" access to care comes with a big price tag. In other countries with government-run health systems, care is rationed, waiting lines are long, and access to the newest medicines and treatments is restricted.
The right solution is to give people more choices of more affordable health coverage and have states, rather than the federal government, target resources to those who need help.
We've seen with the Affordable Care Act how difficult it is for a centrally controlled system to work. The ACA dictated the rules for health insurance policies in the individual and small group markets, including the rich benefits package. Then premiums doubled. Currently, many people have a choice of buying an expensive Obamacare plan or going uninsured.
Between 2015 and 2018, 3 million people dropped insurance, according to the Kaiser Family Foundation. California spent $100 million last fall trying to boost enrollment in its exchange, yet it saw the number of new enrollees shrink by nearly 24 percent.
The problem is cost. The costs of premiums and deductibles can be prohibitive, especially for those who don't get subsidies. One dad trying to provide coverage for his family faced premiums of $4,000 a month for an Obamacare policy in Virginia last year.
The solution is to offer people more choices of plans that meet their needs and that they can afford - which a properly functioning market could provide.
States have decades of experience in overseeing their health insurance markets. One part of the ACA provides an option for State Innovation Waivers to allow states to reallocate existing resources to take better care of those with pre-existing conditions, for example. In the several states that requested ACA innovation waivers, premiums went down and enrollment went up.
States are helping their health insurance markets to recover, offering better choices and lower costs to families struggling to provide for their families, and with better protection for those with pre-existing conditions.
Devolving control to states and ultimately individuals is the right solution, not more centralized Washington control.
Grace-Marie Turner is an expert on health care policy and is the founder and president of the Galen Institute in Paeonian Springs, Va.