The first presidential debate was devoid of health issues. One good thing: we did not hear about either candidate's most recent doctor visit, including headlines that dominated the news like Clinton's pneumonia and Trump's doctor's letter declaring him "in excellent physical health." But the time has come to ask the meaningful questions about the future of health care. From the woman with metastatic breast cancer whose working husband cannot afford health insurance, to policy makers charged with the overall wellbeing of the American people, we are looking for answers to health care questions that will affect our day-to-day lives. Here are the most pressing questions that ought to be addressed in the upcoming presidential debates.
1. Are you committed to health care coverage for all American citizens by the end of your first term in office? Before the ACA, 22.3% of the 200 million Americans aged 18-64 were uninsured. Mr. Trump, if the ACA is repealed, you will have the burden to find new ways for that same 45 million people to have health insurance. Secretary Clinton, if the ACA is not repealed, 11.9% - or 24 million people - continue to be uninsured. How would you change the ACA to cover them? Bill Clinton pointed out that change is needed - not a surprise.
2. Surely we could cover more people if health insurance was more affordable. Right now, insurers are leaving the marketplace exchanges because what they offered was too expensive - for them to provide and for individuals to afford. Past CMS Administrator Berwick published estimates that we waste 1/3 of our health care dollars, which totals a staggering $1 trillion a year. How would you recommend we decrease waste? How much would be saved permitting insurance to be sold across state lines? How would you deal with skyrocketing drug costs? If you are successful, the first to benefit would be payers such as Medicare and commercial insurers. How would any savings from these ideas be passed along to the consumer to reduce the price of health insurance?
3. How would you deal with the mandates to buy health insurance by individuals and employers. For example, would you increase, decrease or abolish the mandates? In your answer, please provide data as to how your solution would make it more likely that all Americans would have coverage.
4. At present, 19 states have not adopted expansion of their Medicaid programs. How would you propose to provide coverage for the people who are eligible for Medicaid in those states?
5. There is a serious problem with access to health care - in other words,
seeing the right provider at the right time at the right place. Waiting times to see a physician are increasing not only in the Veterans Administration, but also in the private sector. How would you deal with improving access? Turning out more doctors and nurses is expensive and takes a long time. What else can be done? What changes in federal policy should be made?
Hopefully, the next president will consider our health to be one of the top issues. We should work together with the goal of affordable health care for all Americans. There are a number of ways to get there - but getting mired in dogma is not one of them. We can start by getting some answers at the next debate.