What We’d Like To Hear About Health Care in Tonight’s Debate

With the second round of the presidential debates upon us, it struck me that despite the fact that the candidates spent nearly one-quarter of their first debate talking about health care, the dialog was limited to haggling over hundreds of billions in  Medicare cuts or savings (depending on the candidate) and personal stories shared by beleaguered Americans who can’t afford care under the current failing system.

Virtually all of the attention has focused on Medicare (no surprise with the all-important senior vote in play) and the stark contrast of the two candidates’ long-term view of the health reform law. There were warnings from the Romney camp about $716 billion cuts in store for Medicare should Obama be reelected, and the specter of nameless, faceless rationing panels who will deny care to innocent seniors. Romney of course has earlier proposed achieving the same savings by turning Medicare into a voucher system, an idea that a new Kaiser Family Foundation study finds would increase expenses for six out of ten seniors.

But as important as those issues are–and there is no question that repealing the Affordable Care Act, gutting Medicaid through block grants to the states and turning Medicare into a voucher-based program would be devastating to the health of the nation–there are so many other issues I’d like to hear about from the candidates tonight.

For starters, I’d like to hear the President respond to the charge from Gov. Romney that the Patient Protection and Affordable Care Act has failed to prevent increases in health care costs since the law was passed in 2010. In fact, Romney argued, health insurance premiums have risen and employers continue to feel burdened by the offering these benefits to their workers. It doesn’t seem too difficult to simply answer that most of the law’s provisions won’t set in until 2014 and furthermore, healthcare spending is growing at the historically low rate of about 4%. In reality, provisions like allowing young adults to stay on their parent’s health plans and doing away with lifetime medical spending limits has increased costs to insurers by only 1-2%. Linking the ACA to increases in health care costs now doesn’t even make sense.

I’d also like to hear more about what evidence is showing to be the real culprit in rising health care costs: The prices of services that include doctor’s fees, hospitalization, surgeries, medical devices and designer cancer drugs are just a few that come to mind.

I’d like to find out how many people will remain uninsured, or alternately, under-insured in the Romney-Ryan view of a “consumer directed” health plan. The ridiculous statement to the Columbus Dispatch by Romney this week that no one in America dies because they don’t have health insurance shows just how divorced from reality this campaign is from the crisis a significant portion of our society faces when they get sick. The simple act of calling programs like Medicare, Social Security and Medicaid “entitlements” is an attempt to give a negative spin to what many consider the great social programs of our time.

Today I came across an interesting piece in the Huffington Post by Scott Bittle and Jean Johnson, both senior fellows at Public Agenda, a nonpartisan research and engagement organization. In it, the authors, who have an ongoing series called “The Question Project” that attempts to elicit more in-depth answers from candidates about a range of issues, take a stab at health care reform. Their view is that Americans ” deserve a more candid and less manipulative conversation than they’ve got.” You can access the full post here, but here are the pithy questions Bittle and Johnson would like to see Obama and Romney answer:

• Here’s an issue neither presidential candidate bothers to address: The Congressional Budget Office has concluded that the “growth in real spending on health care was principally the result of the emergence of new medical technologies and services and their adoption and widespread diffusion” by the U.S. health care system. But better tools for diagnosis and better procedures and drugs for treatment are precisely what many Americans value most about our system. To what degree do you believe that advancing technology has improved care? How would your ideas affect spending in this area?
• Governor Romney, you’ve argued that more competition in the system could play an important role in stabilizing costs. But health insurance companies have competed for business among employers for years. Businesses have every incentive to keep costs down, and bargain as hard as they can, and yet health insurance costs have continued to spiral. Why hasn’t competition in the business-to-business market been more effective? Why do you think your ideas would be more successful in this regard?
• President Obama, you’ve said that your plan “would change incentives so that providers will give patients the best care, not just the most expensive care, which will mean big savings over time.” But we’ve seen numerous attempts to change incentives in health care, “managed care” and HMOs, for example. Not only were they not popular, they didn’t make much of a dent in rising health costs. Why would your idea for “accountable care organizations” work better?
• The vast majority of health care costs come from a small number of very sick patients who have catastrophic injuries or diseases or suffer from multiple serious and chronic health problems. Tell us why you believe your ideas to control costs will accomplish their goals in a humane and conscionable way? How would the ideas you’ve put forward affect people with very serious illnesses?
• There’s been a lot of discussion about the power of patients “shopping around” for both insurance and health care. Realistically, however, doctors, not patients, make most of the decisions about tests, drugs, and procedures. Patients have a lot more information than they used to, but many patients still either don’t have an incentive to question the doctor or don’t feel they have the expertise to do so. In addition, a health insurance plan is a pretty complicated financial instrument — and the mortgage crisis showed that the public can have problems dealing with complex financial issues. In your view, how do we make individuals the savvy health consumers they need to be? And what about the doctors — how would your ideas insure that doctors are focusing on doing the best for their patients, but in cost-effective and ethical way?
• Many experts believe that Americans would be healthier, and the country would be more successful in controlling rising costs if we could find effective ways to reduce smoking, obesity, substance abuse, and accidents? How much do you believe these factors contribute to rising health care costs, and do you see a role for government in this area? If so, do you think government’s role should be primarily educational or are there other steps we should take?