What every presidential Democratic candidate — many of whom will be speaking at the Iowa State Fair this week — should know about Iowa health reform:

1. Iowa suffered greatly by having a Republican-dominated state government (governor, Senate, and House) during the aftermath of the enactment of the Affordable Care Act (ACA). With a Republican governor and most recently a Republican Senate and House in Iowa, we had a miserable attempt at a Marketplace/Exchange; no support for our attempt at a health-care Co-Op (Co-Oportunity Health, which had 120,000 members in one year of operation); passage of association health plans, which allow for discrimination against persons with co-existing conditions; and, overall, an unbelievably negative atmosphere in general regarding anything that concerned the ACA.

2. While then-Governor Terry Branstad did allow for Medicaid expansion, he did it with a plan for a takeover of Medicaid by for-profit companies, which has been a fiasco with comings and goings of different managed-care companies. Iowa has given these companies rate increases of more than 6 percent for two years in a row. Providers have fared much worse.

3. Despite these facts, Iowa has maintained its reasonably good health status due to its citizenry and providers.

4. “Medicare for All” proponents should know that — due to a flawed, decades-old formula of regional Medicare reimbursement — Iowa has suffered greatly. No “Medicare for All” proponent should promote it in Iowa without acknowledging this failed reimbursement system and having a fix for it in their plan.

My top three Democratic candidates as of now:
1. Joe Biden
2. Elizabeth Warren
3. No one

I am intrigued with Pete Buttigieg, who, for me, came up with the most cogent comment of the campaign so far:

“It is time to stop worrying about what the Republicans will say. Look, if it’s true that if we embrace a far-left agenda, they’re going to say we’re a bunch of crazy socialists; if we embrace a conservative agenda, you know what they’re going to do? They’re going to say we’re a bunch of crazy socialists. So let’s just stand up for the right policy, go out there, and defend it.”

I also like the next part of that quotation:

“That’s the policy I’m putting forward, not because I think it’s the right triangulation between Republicans here and Democrats there — because I think it’s the right answer for people like my mother-in-law, who is here, whose life was saved by the ACA, but who is still far too vulnerable to the fact that the insurance industry does not care.”