In her long Senate career, Susan Collins has always been able to find the middle on health care policy.

Look at her position on the Affordable Care Act: She never supported Barack Obama’s sweeping reforms, but in 2017 she cast a crucial vote to save it from repeal, saying such a move would put the security of too many of her constituents at risk.

That didn’t stop her just a few months later from voting for a tax bill that eliminated a key element of the health care law – the mandate that everyone buy insurance or pay a tax penalty – putting Obamacare in danger of being killed in the courts.

In the meantime she has backed a number of health care bills, often co-sponsored with Democrats, that focus on specific aspects of health policy. They are usually good ideas that would have strong support but tend to disappear into the void of a legislative body that can only confirm judges and pass emergency budget stopgaps.

So when Collins and the three candidates trying to displace her took the debate stage Sept. 11, it was no surprise that one of the first questions would be on health care. And it was no surprise that Collins would be ready for it.

Asked what she would do to address the flaws of a health care system that have been exposed by the coronavirus pandemic and resulting economic upheaval, Collins rolled out one of her signature good ideas: price transparency.

Collins is a co-sponsor of a bill that would require hospitals to list their real prices for procedures and make insurers provide accurate and timely information to their customers. If enacted, it would let patients shop around for the best deals, in theory forcing providers to compete on price.

Not knowing how much anything costs until you get the bill is definitely a problem with our health care system. But with millions of Americans still uninsured and millions more opting for high-deductible plans that discourage them from getting anything but emergency care, is it “the” problem?

A much bigger debate on health care policy is taking place inside the Democratic Party, or in this Senate race, between Democrat Sara Gideon and independent Lisa Savage.

Savage supports “Medicare for All,” a national single-payer, universal coverage system, like Canada’s but more comprehensive. Her proposal is similar to the plans promoted by Democratic presidential candidates Bernie Sanders and Elizabeth Warren, which would replace private insurance with a government-run plan. Instead of paying premiums based on their level of coverage, enrollees would pay a tax based on their income.

Gideon has adopted the moderate, incremental approach backed by Democratic presidential nominee Joe Biden, which would expand the Affordable Care Act by, in part, supplementing the private insurance market with a Medicare-like public option. Gideon also wants to use the market clout of the federal government to negotiate lower prescription drug prices.

These are big, meaty issues that affect hundreds of millions of lives. In comparison, helping consumers shop around for providers, assuming that there’s no emergency and they live in a place where they have options, comes across as kind of small.

The problem for Collins is that her party has put her in a box. There is no Republican health care reform plan. The party isn’t even trying to offer an alternative to the Democrats. 

It’s not just Republican office holders. A Pew Research Center poll released in August asked likely voters what issues were most important to them in the upcoming election. More than two-thirds said health care (68 percent), coming in second place only to the economy (79 percent).

But you get a very different picture when the answers are filtered by party. Eighty-two percent of Biden supporters say health care is an important issue, while fewer than half of Trump supporters (48 percent) say the same. 

If Collins were trying to get only Republican votes, she would not need much of a health care agenda. But to win in Maine, she will need Biden voters to pick her over Gideon or Savage. 

Collins needs those voters to decide that even though Biden should be president, they want him surrounded by senators like Collins who oppose his policies – a rational choice if you think the health care system is basically OK and you don’t want the government to do much about it.

Gridlock is less popular with people who want to see change. This is one time that Collins’ instinct for the middle could leave her out in the cold.


Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.