Health concerns consistently show up among the top issues in political polls, but few pundits see candidates’ positions on health issues affecting voter decisions. It’s not that candidates agree about what should be done or that voters think government can’t do anything to help. In fact, public expectations for government action remain high and there are often rich differences between candidates’ positions.
The problem is that health is a “hot button” for candidates. A misstatement can be disastrous. As a result, serious discussion often quickly deteriorates into political banality. Instead of providing thoughtful specifics about their proposals, candidates respond with glittering generalities. Few voters feel they know enough to push politicians beyond generalities and health issues are simply not discussed meaningfully.
Two basic questions can lead to a robust political discussion. Neither of them have a “right” answer, but the politician’s responses will tell you a lot about the policy choices candidates are likely to pursue if elected.
How will you make the health system fairer?
Over the last few years, the Washington Health Foundation has conducted surveys and convened meetings around the state to gather input about health issues directly from residents. Results have shown that improving fairness in the health system is broadly seen as the top priority.
To many people, “fairness” means that everyone has access to comprehensive, affordable health services. To others, it means that people should pay only for health services they use. Some believe they are paying unfairly high prices for health services, while others focus on people who aren’t treated because they can’t afford the services.
Obviously, every candidate will advocate for a “fair” health system. Voters must ask for specifics.
For example, what are the specific steps the candidate believes government should take to make the health system fairer? Virtually every candidate, conservative or liberal, will respond by citing the high number of people without health insurance and suggest that a first step is to get everyone insurance coverage. Not surprisingly, views differ about how to reach this goal.
Some candidates believe that a wholesale reform of the system is necessary, including those who advocate for a national health insurance plan, similar to Medicare, that would cover all legal residents. Others propose modifying state laws to permit inexpensive, stripped down insurance plans covering limited, basic medical services. Some see new types of insurance such as medical savings accounts as the answer.
Whatever option the candidate favors, make sure he or she tells you what health services the plans will be required to cover, who will pay for them and whether they think health-care costs should be spread generally across society or apportioned to those who use the most services.
Also, we know that other barriers exist for people trying to access health care. Even people with insurance may face great difficulties understanding the details of their coverage or finding the services they need. Make sure that the candidate addresses these issues as well. What is government’s role in helping people overcome these barriers?
How will you safeguard Washingtonians through our public health systems?
Health experts of all political stripes agree that dollar for dollar, public health programs are the proven, cost-effective ways to improve health. Yet, governments spend less than 4 percent of their $1.7 trillion health budgets nationally for public health.
While we may not think about them often, the benefits of public health programs are clear. We take safe drinking water, clean air, sewage systems and food safety inspections for granted. We expect public health officials to take immediate steps to protect us from diseases such as e-coli, West Nile virus or SARS. Police, fire and medical system workers look to public health to coordinate our first line of defense in potential biological or chemical terrorist attacks. More and more, we expect public health agencies to take the lead in promoting healthy lifestyles to combat diseases ranging from cancer to obesity.
While the need for these services is clear and growing, the methods to sustain them are not. Preventing future illness or injury frequently loses out to paying for “here and now” problems when tightening government budgets must be balanced. Public health budgets across Washington are decreasing just as needs are growing.
Once again, voters must ask for specifics. What changes are needed to improve public health infrastructure and who should pay for it?
Listen carefully to the details of candidates’ health proposals and keep asking questions until their answers are clear to you. Then draw your own conclusions about how well the candidate addresses fairness and public health issues. You will learn a lot and you will also send a message to politicians that glittering generalities are not enough.
Greg Vigdor is president and CEO of the nonprofit Washington Health Foundation.
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