Jeff Levine's picture

The Presidential Debates – A Healthy Discussion?

Jeff Levine is an award-winning journalist who was the medical correspondent for CNN for 17 years.  He has also worked on Capitol Hill for Senator Byron Dorgan, as Washington bureau chief for WebMD, and as a media specialist at Ketchum. A guest contributor to Health-E Minds, the following post represents Jeff’s perspective on the presidential election debates, based on his opinions generated during his many years of observing and reporting on healthcare and politics. – Nancy Hicks, Senior Vice President, Associate Director, Ketchum North America Healthcare Practice

With tonight’s second presidential debate
just [[wysiwyg_imageupload:139:height=167,width=253]]hours away, a look back on the first debate offers insights into what we might expect to see this evening, particularly from a healthcare reform perspective. 

It’s not surprising that the first presidential debate focused largely on fixing the nation’s health care system.  No question it’s a big problem, but we needed to hear more about where we need to go and less about the fine print in the opposing plans. 

The non-partisan Kaiser Family Foundation says US health care expenditures approached $2.6 trillion in 2010…more than ten times the amount spent in 1980.

The Kaiser analysis concludes, “[the cost of health care] is still expected to grow faster than the national income over the foreseeable future.”

If there were a simple solution—either by government action or private market initiative—we certainly would have seen it by now.

The Affordable Care Act, or Obamacare—a term the president has come to embrace—is a partial solution but remains exceedingly complex and easy to distort.  Since its passage in 2010 the law has been the target of Republicans who say it’s a “government takeover of healthcare.”

With that as a curtain raiser to the debate, it was an opportunity for both candidates to lay out their visions about the one issue that affects every American.

Why didn’t that happen? 

While the public likes many consumer-friendly aspects of the new health care law, the whole is viewed by many to be more negative than the sum of its beneficial parts.  

Republicans see this as a political opportunity, and while they’ve voted to repeal and replace all or parts of the law more than thirty times in the House, they haven’t put forth a meaningful alternative—other than familiar market-based incentives which have yet to dent the cost and access crisis facing American health care.

Thus Governor Romney carried the Republican standard into the verbal battle saying the president was, in effect, fiddling with health care while the US economy was burning.  Still, it would be hard to tackle the recession without taking notice that US health care spending consumed almost 18 percent of the gross domestic product in 2010, again from the Kaiser Family Foundation.

Other points of contention included proposed Medicare cuts and whether an independent payment board would ultimately determine the kinds of treatments available to patients.  

Romney says he’ll preserve Medicare as an option, but the full benefit program today’s seniors enjoy will disappear and be replaced by what amounts to a voucher.  Obama does cut Medicare growth but offers some additional benefits to buffer the loss.

The new payment board is supposed to find the best treatments at the lowest cost but not without Congressional oversight.   It’s not this year’s version of a “death panel”. 

Romney says he wants the states to craft their own solution to health care, something that hasn’t happened since the Constitution was ratified in 1789 though theoretically possible.   Ironically, Romney care in Massachusetts was the model for Obamacare, but, Romney says, not necessarily ready for export to other venues.   

The philosophical basis for Romney’s original plan and Obamacare can be traced to Stuart Butler at the conservative Heritage Foundation.  He suggested that individuals be required to buy insurance in lieu of a big government entitlement program.   In Massachusetts and under Obamacare, government plays many roles including expanding the market for private insurance. 

Since both Congress and the US Supreme Court have affirmed that the federal government has the right and responsibility to rationalize the healthcare system, it’s hard to see the wisdom of leaving this matter to the states – which lack the resources – many of which also having  anti-reform agendas driven by political interests.

Romney’s idea of turning the Medicaid program for the poor over to the states in a block grant approach isn’t new.  But like a Medicare voucher no one knows how much health care a block grant will buy over time, even with cost-of-living plus one percent annual increases.   There are bound to be benefit variations among the states with some being more equal than others.

Obscured in the point-counterpoint is the reality that government with a big or small “g” has an obligation to take care of its citizens.  Philosophers call this a social contract, and other Western democracies have embraced this responsibility and its commensurate cost more graciously than we have.

Aside from compelling moral arguments, there are the grim economic facts—we spend a lot more on health care than any other nation without getting quality outcomes on a consistent basis.   Going to the emergency room, in spite of what Romney says, is not only an inefficient way to provide care for the uninsured, it will result in those costs either rebounding to the patient or being shifted to other payers.

In fact, health care costs are the elephant in the emergency room.  Fifty million Americans without coverage is an unsustainable number.  Every president since Theodore Roosevelt has tried to find the solution, and finally we do have something in place.

If not Obamacare, then what? The answer may be buried in the numbers and counter claims but the big picture didn't emerge from the first presidential debate. 

The devil may be in the details, but I personally believe that the angels are on the side of reform.  With tonight’s debate looming, America will be watching with great interest to see how the healthcare reform discussion continues to unfold.