Where’s the beef?

Richard Fulton

Our presidential election seems to be dominated by name calling, threats of dire consequences, questioning of honesty, veiled threats, and a host of rather nasty implications.

There are healthier things for our country and its people to talk about in this campaign, but they get lost in the doggerel of rhetoric popular with candidates at all levels of our national politics.

Where are the debates over key problems facing the American polity? There is a continuing growth of our national debt, are there any solutions to this excessive growth evident in this year’s campaigning?

I know that the United States is only 28th in the world measured in debt to GDP ratio (the most rational way to judge the seriousness of the problem), but is this acceptable?

What about the problem of tax reform? Sure, both presidential candidates talk about cutting taxes for this or that category of citizens, but how do you reform the unconscionable complexity of the tax codes to spur economic growth and to insure at least relative fairness? This is worth talking about besides who gets wholesale tax cuts or who gets tax hikes.

Long term financing of Medicare and Social Security might be a good topic for in-depth debate. Just to say that armageddon is on the horizon or that we’re safe until, what 2025 or 2040?, is not enough.

Let me explore the health issue in particular.

Where is the serious talk about reforming Obamacare, to adjust the law to problems seen by its implementation? Republicans have met the problem of how to adjust this huge program by voting over 100 times to get rid of it. But they have not once given a comprehensive alternative.

Democrats want to wait until after the election to touch the subject. Are they afraid that the people don’t understand the program?

Courts have upheld the program and tens of millions of people have gained health care for the first time in their lives, so who’s going to take this away from them? Obviously this would be cruel without an operational alternative.

Insurance companies are bailing from insurance exchanges used to get health insurance to as many as possible. These exchanges help those not in corporate health programs or in Medicare. They help the very poor. This leaves the middle class and those with jobs without company health plans to continue with the private plans insurance companies offer.

Insurance companies did not do a good job in predicting the demand for and costs of providing insurance in this atmosphere, so they are cutting and running from some state health exchanges. They are losing money. They are raising premiums.

What most don’t remember is that they raised premiums just as high before Obamacare. Some cooperative initiatives will be needed after the election.

At the state level, the federal program to aid states in expanding Medicaid for the very poor seems to be working in those states that took up the federal program. Missouri did not but red states like Arkansas and Kentucky did.

A recent Harvard research team’s study found that after only two years of accepting the monies for our poorest people to have health care, these two states have had significant success with expanded Medicaid. It will take time to gage the ultimate affect, but the study found “broad based improvements that we would expect with better (health) access…”

They contrasted these two accepting states with Texas that refused the extra program and its billions of dollars. The poor without health care dropped from 40 percent to 14 percent in Arkansas and 9 percent in Kentucky. In Texas the uninsured rate dropped from 39 percent to 32 percent.

Significantly more chronically ill poor patients were getting regular care in the two Medicaid supplement states, Texas found fewer poor getting checkups or chronically ill support.

It would be nice to have such a study on Missouri. Want to bet we would come out just like Texas? Better still, it would be nice to see this issue even mentioned in the current state and national political debates.

Serious issues demand serious debates.

See: Dr. Benjamin Sommers, JAMA Internal Medicine, August 8, 2016.