February 3, 2019

CHANG | Students: Make a Vote for Health Care

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Unlike Iran policy, central bank reform or wildlife conservation, health care is a quotidian issue. The cost of premiums and copays are a consistent burden for the 28 percent of working-age adults who are underinsured. The price of prescriptions and hospital visits can’t be ignored without serious effects on economic stability. The future of health care is a hot topic, and it would behoove candidates (presidential, congressional and otherwise) and voters to pay attention.

The debate over the state of our health care system has consumed classrooms (shoutout to PAM 2350: the U.S. Healthcare System), dining rooms, the pages of health care and medical journals and the Congressional floor. Yet, the plenitude of lively conversations haven’t generated a conclusive evaluation or solution.The latest studies indicate that the U.S. health care system has serious failings, even though American citizens pay a comparatively enormous amount for medical treatment.

Somewhere between 27 and 30 million Americans are still uninsured. Dr. David Ansell, professor of internal medicine and senior vice president at Rush University Medical Center, uses the term “death gaps” to describe how the lack of affordable private insurance and the difficulty of purchasing health insurance through the Affordable Care Act marketplace abandons lower-income folks. The result is a class-segregated health care system that leads to drastically lower health outcomes and higher death rates (45,000 deaths per year, according to a Harvard study) for the uninsured.

Beyond uninsurance, the our health care system also suffers from administrative inefficiency and underperforming primary care, according to the Commonwealth Fund, which ranked the United States dead last in its list of health care systems in developed countries. Add those metrics to Swedish economist Anders Åslund’s list of issues that include the tort industry, physician incomes and the pharmaceutical industry’s monopoly. There are a laundry list of problems.

So why does this matter, and how should we vote on health care in 2020?

First, we’ll need insurance soon. Most of us are probably still on our parent’s insurance plans. Maybe some of us shell out thousands for Cornell’s Student Health Plan. But by the time we turn 26, we’ll need to have something figured out. Sure, we might get that dream job at that investment bank which offers practically perfect insurance or we might still be in medical school, but we should prepare for a worst-case scenario. At least that’s what I’ll be doing, because a long medical history could royally screw my quest for insurance.

Second, the ballooning costs of health care could change our tax structure and  economic health in the near future. $38.2 trillion of $45.8 trillion in government obligations is unfunded Medicare and Medicaid payments. By 2037, the Congressional Budget Office projects the debt to GDP ratio to increase to over 300 percent. As our debt burden crowd out investments, consumer spending and forces entitlement spending to become insolvent, we’ll be in a serious economic mess.

My goal when picking presidential and congressional candidates in 2020 is to gain a sense of how their health care proposals or stances will affect me. In the 2018 midterm election, we saw a preview of how the health care conversation will play out for the 2020 midterm elections. Although fewer than 20 percent of advertisements mentioned health care in the 2016 election, over half of Democratic advertisements and nearly one-third of Republican advertisements highlighted healthcare in 2018. Forty-five percent of Democratic voters want a Democratic president and Congress to address health care as their top priority. No candidate can ignore the siren song to focus on health care.

Democrats harped on their moral high ground as the defenders of stronger protections for pre-existing conditions and warriors for a re-invigorated ACA. They tore up Republicans and President Trump for rolling back crucial sections of Obamacare, such as the individual mandate, and pushing piecemeal insurance plans, like the short-term limited-duration health plans.

On the other hand, Republicans often played defense, ignoring health care or shifting policy positions to advocate for protecting individual protections. This only worked partially, reducing the number of seats Republicans lost in the midterms, but may be untenable for a new election in which health care is even more important.

That’s not to say the Republicans have already lost the health care debate for 2020. The nexus question will be whether we should pursue piecemeal reform through the the state innovation approach or a sweeping change vis-á-vis single-payer or another variant of universal health insurance. Democratic Senators and presidential candidates Kamala Harris (D-Calif.), Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.) and Cory Booker (D-N.J.) have already come out in favor of Medicare-for-all, a solution popularized by Sen. Bernie Sanders (I-Vt.). The details of different plans will slowly emerge as we wade closer to the primary dates.

Each individual’s health care needs are different and parsing out each proposal’s efficacy is a task for individual voters. Regardless, we should pay more attention to the techne of the health care debate. In 2020, we should vote for the future of health care. We should seek economically sensible and affordable solutions that work for students and young adults alike.

Darren Chang is a sophomore in the College of Arts and Sciences. Swamp Snorkeling runs every other Monday this semester. He can be reached at dchang@cornellsun.com.