The stakes are high in the debate over health care, and the health industry millionaire and billionaires aren’t going to give up their means of acquiring wealth easily.

The Sackler family made a literal killing hooking Americans on opioids, and are now trying to shield their ill-gotten gains from lawsuits. Private equity firms, it turns out, are the profiteering “owners” of physicians across the country, gouging people through surprise billing for hospital treatment. Across the industry, executives of insurance companies, hospitals, and drug companies demand multi-million dollar salaries.

Will it make a difference that the curtain of how health care executives got rich has been pulled back, at least a little? Will Democratic candidates’ promises of reforms work?

People are paying more than everfor health care. Added to all this, the percentage of people without health insurance coverage is creeping up again, both nationally and in Washington State. Although most of the big gains in insurance coverage following passage of Obamacare remain, the number and percentage of uninsured people have increased each year since 2016.

The need for national reform has caught the attention of politicians and the American people. From the Democratic campaign trail, candidates are passionately arguing for their visions of a reformed system. All of the major candidates say they support the principle of “Medicare for All,” except for former Vice President Joe Biden, Senator AmyKlobuchar and former Representative Beto O’Rourke.

Among Americans, it turns out, slogans like that that mean entirely different things to different people.

Senator Bernie Sanders and Senator Elizabeth Warren support a national single-payer health care system with no premiums or deductibles. While Sanders’ plan would dramatically limit the role of private insurance, Warren’s would eliminate it entirely. Andrew Yang and SenatorKamala Harris also support moving to everyone in Medicare, with Harris providing for a 10-year phase in.

Mayor Pete Buttigieg and Julian Castro propose letting anyone choose Medicare, while largely preserving the private insurance industry. Senator Cory Booker is somewherein the middle.

Meanwhile, Biden’s campaign is also actively working to undercut support for actual Medicare for all.

These candidates offer differing levels of detail about addressing other issues in our health care system on their official websites. In fact, the American people are less concerned about a catchy slogan and instead care more about lowering the costs of their drugs and care, preserving coverage protections for all people, including those with pre-existing conditions, and putting an end to surprise billing.

As we approach the 2020 election, recent history offers numerous examples of thwarted policy initiatives that would have created a universal health coverage system. In 1974, President Richard Nixon proposed an expanded public program and universal employer health coverage mandate only to have the Watergate scandal undermine his presidency and reputation. In 1993, President Bill Clinton’s proposal to develop regional health alliances was hampered by millions of dollars in counter-advertising. In 2009, a public option was eliminated from Obamacare in the final months of deliberation largely due to Republican opposition to government involvement in health care and Democratic desire to pass the larger legislation.

These failed attempts offer a teaching moment for the American people. The health care industry accounts for 18 percent of the U.S. economy, making a few people very, very wealthy and able to spend significant amounts of money to save their golden goose. Perverse incentives have created an environment where eight health insurance CEOs have a combined salary of $143.5 million – an average of $18 million each. In order to see change, national health reform policy will need significant political capital, millions of dollars to fight industry opposition and misinformation, and united public support.

The current U.S. health care system is unacceptable. Patient medical bills account for half of unpaid bills sent to debt collectors. The degree of fragmentation leaves people frequently scrambling for coverage or postponing needed treatment. One in three women have to change their health insurance coverage during their pregnancy.

In order to provide everyone with the health care they need, policymakers and the American people have to move past slogans and demand systemic changes that eliminate the profiteering and the inequity that leave our system broken.