The fate of American health-care reform is on the ballot this November

The fate of American health-care reform is on the ballot this November
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With the midterm elections just weeks away, concerns about health care continue to rank among the top issues for most voters. A recent Kaiser Family Foundation (KFF) poll reported that 80 percent of people thought health care was the most important or a very important issue for 2018 candidates to talk about. A late September Pew poll showed health care as the second most frequently mentioned issue voters considered important. 

The truth is, voters are right to be seriously concerned about the state of our health care system. Costs are high and growing rapidly. The goal of delivering quality health care at affordable prices remains elusive. In the face of these very real and difficult challenges, lawmakers have achieved little, settling instead for tired campaign slogans — “Repeal and Replace ObamaCare” vs “Medicare for all” — that suggest simple solutions are available.

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This flawed framing of the political dialogue has trapped our elected officials in unproductive debates. They are too narrowly focused, inadequately informed by relevant facts and experience; and more concerned with winning political points and preserving existing institutions than with improving health care or reducing costs.

Moving past or through this unnecessary gridlock requires viewing the realities of our health care within a broader context, which includes all of the relevant facts. We must also recognize that actions and non-actions have consequences and that we need to pay attention to that dynamic.

Within such a broader context, health care’s effect on other things is more apparent and more troubling. We are all aware that health-care costs are high and rising in this country. This is not just for the federal government, but also for state governments, employers and households. We are less aware, however, to the degree to which these rising costs are crowding out just about everything else

Consider, for example, that over the past decade private premiums and deductibles have grown by over 50 percent while wages have barely grown faster than inflation; Medicaid costs have grown to consume three-tenths of state budgets, up from one-fifth; and federal health care spending has nearly doubled, while discretionary appropriations on national security and investments have grown only 15 percent.

There are links that make it disturbingly apparent that the American health-care system affects not just our health, but also our personal and governmental budgets; our wages and the cost of doing business, our ability to educate our children, care for our elderly, maintain our roads and bridges; and protect our grandchildren’s economic future.

The good news is that the issue’s prominence in the election presents an opportunity to issue a clear public mandate that would encourage Congress to provide the needed leadership on this issue. It is crucial policymakers embrace an urgent, but more nuanced discussion that accounts for the complex interactions amongst demographics, usage, costs, accessibility, equity, technology and science, location, provider workforce, subsidies and insurance on the one hand and the need for quality outcomes, fiscal sustainability and managerial efficacy on the other.

But none of this will happen unless we, as voters, as consumers of health care and taxpayers, encourage members of the next Congress to improve the quality of the health care debate so it focuses on truly fixing the many shortcomings in the system.

Mark Litow is a director of the Concerned Actuaries Group and a former principal at Milliman. Marc Goldwein is the senior vice president and senior policy director for the Committee for a Responsible Federal Budget.