The sword of Damocles is set to swing again as Republicans rush to "repeal and replace" Obamacare as promised, Democrats defend it as promised and the public fears whatever happens or doesn't may not be good for their health. Literally.
The conversation about health care reform is reaching full din, fueled by tweets and taunts creating fear and loathing. The politics over health care has become a grim sequel to The Hunger Games, where survival belongs to the fittest and winning reserved for those with the most and/or best lobbyists in Washington.
Many have taken to protesting the specifics of the various Republican health reform plans, proclaiming this will make or break political careers as it threatens and imperils lives.
In this rush to Armageddon, political consultants counsel a simple, simplistic stratagem: "Don't give an inch."
Make the other guys own it, make them hurt, fomenting a fishbowl of shame where virtue is no match for vitriol.
Let's be honest. The canyon dividing us on health care has widened into a chasm fueled by false expectations and failed delivery.
On the one hand the Affordable Care Act is far less affordable and far more illusory than promised, as we see premiums soar and insurers flee state-based exchanges.
On the other hand, the various versions of the Republicans' American Health Care Act, designed to offer financial solidity and coverage certainty, are yet to merit public confidence as detractors hit them as purposely heartless.
As the self-imposed, "we've got to get it done now or we're political toast" clock ticks ever louder for Republicans, a looming truth leads to a even starker question. Is it better to possibly do further harm to a failing system or do nothing to let the system itself fail?
Here's the bitter truth. Everyone has to give a little to truly heal health care in America. Everyone.
In my view, here are five realities we must acknowledge and address to remedy what ails us:
1. Costs must go down. Soaring premiums and deductibles foster the fear that soon many can't afford it, and/or that government will no longer subsidize it. This is where insurers, providers and drug companies can show they're willing to make a little less for the common good.
2. Consumers must recalibrate expectations. Getting everything they want, whenever they want it, does not come free. We can't afford everything. The Affordable Care Act mandated a full plate of essential benefits, and many states add to that burden with additional mandates. Something's got to give.
3. Meaningful coverage for people with pre-existing conditions. This should not be open to nuance but ensured as an act of conscience. Enough said.
4. More flexibility for states. The feds must give the states even more flexibility, not budget-crunching debt, to deal with more and more Americans on Medicaid — 75 million of them, and counting.
5. Don't fix Obamacare or Trumpcare. People want Congress to fix health care, and they are willing to wait a little longer to make sure we get it right.
For every working family squeezed by stagnant wages and soaring premiums. For every individual living on the edge of poverty who doesn't technically qualify for more coverage. For every small business forced to choose between providing coverage and providing jobs. For every American who wants to know they won't be left desperate and destitute when — not if — illness knocks on their door.
My advice to Congress: Stop bashing each other over who's to blame. Stop checking your donor lists to see whom you might offend. Bring this conversation out of Congress' back rooms and into America's living rooms. Bring everyone back to the table, and ask what each is willing to forfeit or forgo for the sake of the greater good.
Imperfect as it is, the plan advanced by Nebraska Sen. Ben Sasse makes sense. Repeal first, then take a full calendar year (not a short summer session) to craft a remedy that's reasonable and sustainable.
The goal remains the same: Delivering the best care at the lowest cost to the greatest number of people. The intention remains the same — do the right thing at the right time for the right reasons.
More than ever, the need remains the same: protecting and advancing our health. We need to get this right.
Adam Goodman is a national Republican media consultant based in St. Petersburg and the first Edward R. Murrow Fellow at Tufts University's Fletcher School of Law and Diplomacy. He wrote this exclusively for the Tampa Bay Times.