Deep in my immigrant’s heart there resides a lingering idealism about American presidential campaigns: They should feature edifying debate about the critical issues we face as a nation. Just as Lincoln argued about slavery with Douglas, Reagan about American strength in a dangerous world with Carter, and Obama about the collapse of the housing market with McCain.
I know I’m not alone in feeling tremendously let down by an electoral contest dominated by tawdry, 24/7 coverage of sexual abasement, cheap cruelties directed at beauty queens, and office-in-home email servers.
My disappointment is heightened by the fact that it’s my job to run the nation’s largest public health care system. And therefore, I’m painfully aware of how costly the failure to address inequities in health care will be to all of us.
Unfortunately, the candidates, news outlets, and analysts have all paid too little interest in discussing health care over the past year, and we Americans are much poorer for it.
My hunch is that if Secretary Clinton had a more serious minded opponent, her inner policy wonk would shine and we might have spent the campaign season discussing health care payment, access and delivery system reform. But in an era when Dancing with the Stars is more influential than Meet the Press or Face the Nation, it takes two to tango. And Donald Trump has proved an unwilling partner to any serious discussion about what’s working in the post Affordable Care Act implementation era, what needs fixing, and what remains unfinished business.
Whether you are pro Obamacare, or against it, whether you favor a single payer system or one that’s employer based and more market driven, any serious observer of America’s health care landscape must conclude that it’s too expensive and insufficiently effective. The US is among the highest per capital spenders on health care among wealthy nations, but our health outcomes don’t reflect this. We continue to have shorter life expectancy and greater prevalence of chronic conditions than our competitors in other high income nations. Health disparities remain wide, especially in underserved and minority communities across the five boroughs and the fifty states, even after the ACA helped 16 million more people get health insurance coverage.
Obamacare was just the most recent chapter in a proud and progressive belief on the part of Americans that our nation is stronger if all are healthier. The law is not perfect. Overhauls to the nation’s health care never have been. The 1965 law authorizing Medicare, for example, is revisited regularly to make course changes and technical corrections.
Flaws like the ACA’s unconscionable exclusion of undocumented residents, the need for greater subsidies for purchasing insurance, the need for more enforcement to drive healthy Americans to buy insurance, and the need to strengthen insurance marketplaces to encourage healthy competition, all should be on the agenda of the next president and the next Congress. And they should have been more visible topics throughout this presidential campaign. Perhaps tonight’s debate will surprise us by offering a substantive discussion of health care. Now, that would be an exciting new twist worthy of the headlines.