Democratic presidential candidates (left to right) New York City Mayor Bill de Blasio; Rep. Tim Ryan D-Ohio; former Housing Sec. Julian Castro; Sen. Cory Booker D-N.J.; Sen. Elizabeth Warren, D-Mass.; former Rep. Beto O’Rourke, D-Texas.; Sen. Amy Klobuchar, D-Minn; Rep. Tulsi Gabbard, D-Hawaii; Washington Gov. Jay Inslee; and former U.S. Rep. John Delaney (Maryland), listen to a question during the Democratic primary debate hosted by NBC News at the Adrienne Arsht Center for the Performing Arts, June 26, in Miami. (Wilfredo Lee / Associated Press)

Democratic presidential candidates (left to right) New York City Mayor Bill de Blasio; Rep. Tim Ryan D-Ohio; former Housing Sec. Julian Castro; Sen. Cory Booker D-N.J.; Sen. Elizabeth Warren, D-Mass.; former Rep. Beto O’Rourke, D-Texas.; Sen. Amy Klobuchar, D-Minn; Rep. Tulsi Gabbard, D-Hawaii; Washington Gov. Jay Inslee; and former U.S. Rep. John Delaney (Maryland), listen to a question during the Democratic primary debate hosted by NBC News at the Adrienne Arsht Center for the Performing Arts, June 26, in Miami. (Wilfredo Lee / Associated Press)

Editorial: The health care question that wasn’t asked

While candidates discussed Medicare for All, a Senate committee advanced bills that can lower costs.

By The Herald Editorial Board

Judging by Wednesday’s debate among 10 of the 20 Democratic candidates for president, the only health care issue facing Americans — and one that apparently can be resolved with a show of hands — is whether to adopt Medicare for All or allow the option to buy into the public insurance program.

Never mind that U.S. health care spending totaled $3.5 trillion in 2017 — $10,739 a person — a nearly 4 percent increase over 2016 and amounts to about 18 percent of the nation’s Gross Domestic Product; or that health care insurance and delivery soon could be devastated by a court ruling that could declare the Obama-era Affordable Care Act unconstitutional, leaving millions without insurance and millions more without coverage for pre-existing conditions and other protections.

If those finer details aren’t being addressed by the candidates or debate moderators, they are — pleasant surprise — getting bipartisan attention in Congress.

The Senate’s committee on Health, Education, Labor and Pensions, also on Wednesday, voted 20-3 to approve a package of bills intended to lower health care and prescription drug costs, the Lower Health Care Costs Act. The legislation, shepherded by the committee’s chairman, Sen. Lamar Alexander, R-Tennessee, and its ranking member, Sen. Patty Murray, D-Washington, includes proposals from 36 Democrats and 29 Republicans that seek to end surprise medical billing, provide greater transparency of medical costs before care is provided, increase the availability of more affordable generic medications and make a range of improvements to delivery of public health services.

Tellingly, two of the three committee members to vote against the legislation were Democratic presidential candidates: Sens. Bernie Sanders, I-Vermont, and Elizabeth Warren, D-Massachusetts, who have apparently decided to ignore more immediate solutions in order to fully commit to Medicare for All.

There’s a larger debate that can be had on Medicare for All, an option to buy in to that program or other ways to assure health care coverage, but that debate won’t address more immediate concerns over health care costs and delivery of services.

Among proposals, the Senate legislation could:

End the practice of surprise medical billing, where about 1 in 6 patients who receive care in facilities covered by their insurance network later discover they’ve been billed thousands of dollars for services that weren’t covered by their insurance;

Allow more scrutiny of patents that allow pharmaceutical companies to make small adjustments to medications to extend patent protection and avoid opening the drugs to the generic market, legislation that was earlier introduced by Murray and another Senate Republican; and

Require more transparency in the pricing of medical services and procedures before delivery that would allow patients to shop around and provide some market pressure on prices.

President Trump, earlier in the week, signed an executive order that directs the Health and Human Services agency to begin rule-making to encourage the same price transparency, but that process is lengthy, and Congress might actually beat the president to the punch.

There are few better models for bipartisanship and serious lawmaking than Alexander and Murray. The pair have been partners for years, including their work to reform the No Child Left Behind Act with the Every Child Succeeds Act in 2015.

Yet, even as Murray has a reliable partner in Alexander, she has not shied from criticism of President Trump and other Republicans for actions that have threatened to sabotage and ultimately doom the Affordable Care Act.

Next month, the Trump administration and Republican attorneys general from 18 states are scheduled to argue before the 5th Circuit Court of Appeals, seeking to uphold a Texas District Court judge’s decision that found the ACA unconstitutional.

If that decision is upheld by the appellate court and the U.S. Supreme Court, 21 million Americans could lose their health insurance; another 12 million could lose Medicaid coverage; 133 million Americans with pre-existing conditions — about half the population under 65 — could lose protections that prevent insurance providers from denying them coverage; and 171 million Americans, including 156 million who get their coverage through an employer, could lose the annual and lifetime caps on out-of-pocket expenses that the ACA guarantees.

Murray, in a hearing where the Lower Health Care Costs legislation was introduced earlier this month, said she appreciated the bipartisan work by Congress, but that those efforts couldn’t stop there.

“I am really glad we’ve been able to work together on this legislation, and I’m going to keep making clear it needs to be a first step, not a last one,” she said.

Show of hands, Democrats and Republicans — in Congress and on the campaign trail — who’s in favor of protecting the health care we have now and making it more affordable and accessible for everyone?

Talk to us

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