• Questions I’d like to hear tonight

    I may have to miss the debate tonight. I’m having dinner with a group whom I’m talking to tomorrow about the health care system, and I don’t know when it will end. So I apologize in advance to those of you who were looking forward to my twitter ramblings in real time.

    But every time there is such a debate, I find myself frustrated at the (lack of good) questions about health care and health care policy. So here are the top ten I wish we would hear:

    1. Given that you are in favor of repealing the ACA, how will you help people who have chronic conditions that are no fault of their own obtain health insurance? Even if they can find a plan, how will you help make it affordable?
    2. As part of the repeal of the ACA, the donut hole in the Medicare prescription plan will reopen. Will you tell seniors that they will have to live with this? If you won’t, how will you pay for the continuation of this program?
    3. As part of the repeal of the ACA, many young adults will no longer be able to get insurance on their parents’ plans. As unemployment is high, and adults can’t get Medicaid in most states, what will you do for these Americans?
    4. Estimates show that while plans for converting Medicare into a defined contribution program, such as that approved by the House of Representatives this year, will save the federal government a lot of money in the future, the CBO estimates that much of it will be shifted onto seniors. In fact, up to 68% of health care costs will be paid for by seniors themselves in 2030. How do you think the average American will afford that?
    5. Malpractice reform in Texas has done very little, if anything,to decrease health care spending relative to that of the rest of the country. Given that, why do you keep proposing it as a way to reduce national health care spending?
    6. One of the reasons health insurance costs so much is that health care costs so much. How will you bring down the cost of health care in the United States?
    7. If states could truly “innovate” with Medicaid to make it more affordable, why have almost none asked to do so, even under previous administrations?
    8. Given that more than half of Medicaid spending is for about 5% of enrollees, and that’s mostly for disabled people and Medicare recipients who are dual-eligible for Medicaid, how will you squeeze significant savings out of the half  of Medicaid spending which goes to the other 95%?
    9. It’s easy to cherry pick other countries to find ones we beat on any one metric or another, including wait times. But wait times are not a problem in many other health care systems around the world, which have similar outcomes, and spend far less than we do. Can we learn anything from any of them?
    10. Surveys show that physicians practicing in the US are less satisfied than those practicing in other countries, and think the health care system needs major reform or to be completely rebuilt. In fact, in recent years, more doctors seem to be moving into Canada than moving out. Given that the US has less government regulation of health care than almost any other country, and that doctors make more here than in almost any other country, why do you think this is so?

    Anyway that’s my two cents. Happy to hear your thoughts on this. If I see good ones, in comments, I may elevate them up here as an update.

    UPDATE: Edited for clarity.

    • My question would be a little simpler: “Please explain what the Affordable Care Act does.”

    • The core issue is in your question 6. Politicians have no idea how important the question is, let alone how to answer the question. I would ask the question in a different way. “Why does an appendectomy cost as much as a new Honda Civic in the US, but only as much as a bicycle in Canada, France, Germany, Netherlands, Spain, UK…… ? Do you even care, and if you do what would you do about it?”

    • Why, given the tone and content of the previous debates would anyone expect serious answers by Republicans on health care issues like these questions raise?

    • One could also ask the Republican candidates whether they have health insurance for their own families, and how they obtained it.

      Romney and Cain are multimillionaires. The rest are covered in group plans paid for primarily by taxpayers.

      Republicans are aiming dead-on at older white voters, who basically brought them back in 2010. This is the richest vein of voters in America in terms of reliably going to the polls….they are far more influential than their pure share of the population would indicate.

      Obama made a monstrous miscalculation by letting it slip that his health care reforms would be paid for by cutting back Medicare.
      This enabled the right wing to mobilize the elder fear factor, which is enormous.

      And the really sad part is that Medicare cutbacks will probably not happen anyways.

      Bob hertz