Today’s Managing Health Care Costs Number is Three (ADDENDUM: FOUR)
Last night’s Democratic presidential debate was full of sharp dialog and wonkish policy. Bernie Sanders got a standing ovation when he said “enough about the damn emails”. Martin O’Malley pointed to a family in the audience which lost a daughter to gun violence in Aurora Colorado. He said they were not only prohibited from suing the gun manufacturer, but were “slapped with $200,000 in court costs.” Jim Webb seemed the grumpy curmudgeon when he complained he wasn’t getting enough time, and Lincoln Chafee made many cringe when he whined that his vote in favor of the Patriot Act was the very day he took the oath of office after being appointed to his deceased dad’s seat. Hillary Clinton got the most minutes in the debate, often talked over moderator Anderson Cooper to get in her applause line, and has been widely cited as the winner of the debate.
The loser of the debate, as far as I see it, is health care. Health care is a major issue in the Democratic primary - and the differences between Bernie Sanders and Hillary Clinton are significant.
I counted three times health care was mentioned. The first was during the discussion of gun control, when Sanders pointed to the need for better access to mental health care. That’s true but problematic – the mentally ill are responsible for a small minority of murders although depression is presumably an underlying cause of gun-related suicides, which outnumber gun-related homicides by a factor of two. Mental health advocates are distressed when we keep linking the need for mental health access to gun violence. The conversation returned immediately to guns.
The other significant mentions of health care were two attempts by Hillary Clinton to point to the Children’s Health Insurance Plan (CHIP or SCHIP) as an example of a successful insurance expansion that she worked hard for. She’s right - - CHIP now covers over 8 million children. The program is cheap – because covering kids is inexpensive. This health insurance for kids helps families gain additional economic security. It helps be sure that more kids are vaccinated - which protects us all. There is even evidence that coverage of kidsthrough Medicaid increases college attendance rate and lifelong economic achievement and lowers body mass index! There's every reason to believe the same is true of CHIP. CHIP was reauthorized this past year even amidst the general legislative gridlock - a testimony to how effective the program is. In this era of deep division over the role of government and hyperpartisanship, improvements in health care policy are likely to be incremental like CHIP as opposed to revolutionary like single payer – making CHIP a good model for future health policy initiatives.
I hope we’ll be hearing more about health care policy in the upcoming Democratic debates.
ADDENDUM:
There were actually four mentions of health care. Sanders and Clinton were both asked if they supported allowing undocumented immigrants to purchase health insurance on the exchange. Both said “yes,” which is good from a public health perspective and a policy perspective because we want their children to be vaccinated and we don’t want their expensive hospital stays to be bad debt.
