Why Isn?t Health Care a Major Election Topic?

Thursday, October 6, 2016 | Larry Sobal

The presidential election appears to have the highest degree of polarization and division the country has seen since the Civil War of 1861. Consider the results of various polls:

• 76% of U.S. adults feel this election is “weirder” than past elections
• 70% of people say they feel frustrated with it
• More than 50%, including majorities in both parties, feel angry and helpless
• 57% continue to say that a third major U.S. political party is needed

Despite 88% of Democrats and 81% of Republicans believing that health care and the Affordable Care Act (ACA) are extremely or very important issues, health care seems to be absent from the election discussion so far. With just about 30 days before the election, now seems like a good time to tackle the Clinton and Trump stances on health care and postulate on why it’s a virtually invisible topic.

I get it that the economy and foreign relations are going to get the most attention from Clinton and Trump, but what is most perplexing about the absence of a health care discussion is that the two candidates have such diverse positions on it. For starters, Clinton and Trump propose dramatically different approaches, with Clinton’s being best described as enhancements to the Affordable Care Act (ACA) and  Trump’s health care position being described as a replacement for the ACA. If you want to see the details, the Commonwealth Fund has unveiled an online tool that allows people to compare the health care proposals and see the impact each plan would have on the uninsured rate, the deficit and out-of-pocket costs.

The chart below from a recent Rand analysis shows the impact of the candidates’ respective policies relative to the ACA, insurance coverage and the federal deficit.

 

This chart shows that both candidates’ health care plans increase the federal deficit (although much differently) and also impact the amount of Americans with insurance coverage (also much differently).  One would think that this large degree of variation would demand open rhetoric and debate between Clinton and Trump about health care. 

What also isn’t being discussed is the impact that the transformation of the health care industry has on overall economic growth, particularly employment. After all, one could claim the job growth that carried the U.S. through the recent recession was mostly health care related. When it comes to current and future health care job growth, there's good news and bad news. The good news is that while other sectors of the economy still seem to languish with a slow 8.9% projected growth rate from 2012–2022, health care has a projected 26.5% growth rate. By 2022, recent trends suggest that nearly one in eight U.S. jobs is projected to be in the health care sector. There is no doubt that health care has been, and will continue to be, the dominant job driver in the economy. 

What happens to the overall economy if that begins to change? If you’re paying any attention to health care headlines these days, you see that many hospital and health systems are rapidly shedding jobs. Large layoff announcements are commonplace as health system mergers, decreased hospital volumes and declining reimbursements drive down hospital margins.

The economic impact of health care public policy has a direct impact on the overall economic health of America. For that reason, I suspect that neither candidate is anxious to talk about health care.

 Despite commonly-held assumptions that insurance coverage expansion would spur job growth, this has not been the case. Initiatives around value-based care have been geared toward keeping people out of the hospital through ambulatory care, home health, and preventive medicine. Health care appears to be going through a “rightsizing” and health care job growth will be more likely to occur in non-hospital settings, possibly in much smaller numbers than anticipated.

That means the economic impact of health care public policy has a direct impact on the overall economic health of America. For that reason, I suspect that neither candidate is anxious to talk about health care. Maybe the best we can hope for is that, despite who is elected, our red and blue congressional legislators work to find the courage and unite in a bipartisan “purple” effort to reach consensus on some realistic long-term solutions for health care.   

Tell me what you think.

 

Illustration: Lee Sauer

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

 

 

 

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