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Are We Ignoring Or Just Forgetting About Healthcare During The Debates?

This article is more than 8 years old.

By Yevgeniy Feyman and Alex Verkhivker

Tonight, the first Democratic debate of the election season will kick off. With two GOP debates in the rearview mirror, the first of the debates on the left should offer an opportunity to see how the candidates will distinguish themselves. In particular, one issue that’s been largely absent (at least from the GOP debates beyond “repeal and replace”) is health care. In this coming debate, and in the later GOP debates, the moderators ought to seek out the candidates’ positions on a slew of health care issues.

Medicare and Medicaid

Thus far in the GOP debates, the national debt hasn’t come up as a major issue. Inevitably, it will. The Congressional Budget Office has projected that Medicare and Medicaid will make a substantial dent in federal spending over the next ten years, amounting to one-third of all such spending by 2025. This means that as far as the national debt is concerned, addressing Medicare and Medicaid will be crucial.

Conservative reforms have been made more or less clear – they will typically involve allowing Medicare to compete with private insurance plans and giving more responsibility for Medicaid to the states. But it’s less clear what Democrats would do besides implementing price controls in Medicare Part D. One question the moderators might ask the candidates is how each plans to deal with these two, massive elephants in the room.

Single Payer, Obamacare, and Price Controls

Again, the GOP position on the prospect of government-run insurance programs and the ACA are fairly clear. What a Democratic nominee would do here is less clear.

The two Democratic frontrunners – Hillary Clinton and Bernie Sanders – have both proposed top-down price controls to reduce drug prices for consumers. The moderators should push the candidates to explain their plans in greater detail, and get to the root of what distinguishes the two approaches. More importantly, how would these plans ensure that innovation in the pharmaceutical sector remains unharmed?

Both Clinton and Sanders have also expressed concern about a pillar of the ACA – the “Cadillac Tax” on high-value insurance. The two candidates want to see the 40% excise tax repealed despite a consensus letter from 101 economists explaining that this would be very poor policy. How would the candidates replace the lost revenue (roughly $90 billion over 10 years)?

The Cadillac Tax does more than raise revenue, though. By effectively limiting the tax deduction for employer-sponsored coverage, it would likely help to put pressure on health care spending. While Bernie Sanders favors single-payer – and ostensibly price controls – how Clinton would approach the health care spending question is less clear.

And this is where the single-payer question comes into play. Sanders has been vocal about pointing out that the ACA isn’t enough, and only single-payer will work to heal the country’s health care ills. Would Hillary jump on the single-payer bandwagon, despite her vociferous support of the ACA?

It is time for health care issues to make it into both the Republican and Democratic debates. After all, the candidates’ views on 17 percent of the economy and over a third of total spending should certainly be front-and-center for voters.

Yevgeniy Feyman is a fellow and deputy director of health policy at the Manhattan Institute. You can follow him on Twitter @YFeyman.

Alex Verkhivker is a contributor to Capital Ideas at The University of Chicago Booth School of Business. In prior work, he has worked as an economic researcher with the Federal Trade Commission in Washington and as an Associate Economist at the Federal Reserve Bank of Chicago. You can follow him on Twitter @averkh.