October 7, 2016

What 10 health care experts would ask Trump and Clinton about health care

Daily Briefing

Health care accounts for nearly a fifth of the U.S. economy—but so far in the presidential and vice presidential debates, the candidates running to lead America haven't been asked anything about the subject.

In advance of Sunday's second presidential debate, the Daily Briefing's Josh Zeitlin asked several health experts to contribute questions they'd ask of Hillary Clinton and Donald Trump. Here's how they responded.

Amitabh Chandra

Director of health policy research, Harvard Kennedy School of Government

What is your plan to encourage states that have not participated in the Medicaid expansion to participate?

David Cutler

Otto Eckstein Professor of Applied Economics, Harvard University; former senior health care advisor, Obama Presidential Campaign

Who would you appoint to lead key health agencies, and what would you charge them to do?

Douglas Holtz-Eakin

President, American Action Forum; former director, Congressional Budget Office; former director of domestic and economic policy, McCain Presidential Campaign

How much of a role do you believe the federal government should have in determining how we as individuals spend our health care dollars?

Farzad Mostashari

Founder, Aledade; former National Coordinator for Health Information Technology

Donald Trump: You have said that it's smart to take full advantage of available government subsidies, even if one disagrees with the policy. Should people who qualify for Obamacare exchange subsidies make sure to apply for them?

Hillary Clinton: You recently released a policy statement on the importance of competition in markets. How do you think that smaller independent physician practices can thrive in a value-based world?

Lanhee Chen

David and Diane Steffy Research Fellow, Hoover Institution; Advisor, Marco Rubio Presidential Campaign; Policy Director, Romney-Ryan Presidential Campaign

Do you plan to continue, expand upon, or scale back the payment delivery reforms contained in the Affordable Care Act?

Do you believe the efforts that the Obama Administration has undertaken in this regard have been successful?

Leah Binder

President and CEO, The Leapfrog Group

A recent study in the prestigious medical journal BMJ estimated that over 200,000 people die every year from preventable errors, accidents, and infections in hospitals. That would make hospital errors the third leading cause of death in America. Yet the United States invests less than one-half of one percent of our research dollars on best practices for running hospitals so they minimize deadly errors. Under the Affordable Care Act, Medicare started changing how they pay hospitals, so hospitals can receive higher payments if they perform well, and we've seen some improvements in safety but the problem is still dramatic. What would your administration do to protect patients from harm in hospitals?

Martin Gaynor

E.J. Barone Professor of Economics and Health Policy, Carnegie Mellon University

What are you going to do for the uninsured? Specifically, what would Hillary Clinton do about the currently uninsured, and what would Donald Trump do about those who are uninsured now and those who would be uninsured if the Affordable Care Act was repealed.

We see issues with monopoly power in all parts of the health care sector, including with hospitals, insurers, and pharmaceutical companies, even if the issues are far from identical. That can lead to higher prices, lower quality, and less innovation. What are you going to do about monopoly power in health care?

Nicholas Bagley

Professor of Law, University of Michigan Law School

I'd like to know how they'd deal with consolidation in the health-care industry, and in particular among providers. Is the answer more antitrust enforcement? Divestitures? The public option? Or something else?

Margaret O'Kane

Founder and president, National Committee for Quality Assurance

Mergers and consolidations have created monopolies in many localities resulting in inability of insurers to negotiate affordable rates or keep low performing hospitals out of their networks. Despite efforts on the part of the FTC, the consolidation has continued. What would you do to encourage healthy competition among hospitals and specialty groups?

Robert Wachter

Professor and interim chair of the Department of Medicine at the University of California, San Francisco

What specifically would you do to lower health care costs that would avoid the predictable backlash regarding rationing?

I'd hope for an answer that reflected some understanding of the amount of low-value care we provide (much of which could be eliminated without "rationing"), the inefficiencies embedded in the chaotic current system (with substantial cost reductions possible through better coordination, EHR use, patient engagement), etc. But I'd also hope for an answer that reflected on the fact that we may ultimately need to make some hard choices, since we simply can't do everything for everybody. Taking account of our current political climate, expecting that answer is wishful thinking, of course.

With Trump or Clinton, what will happen in the next era of health care reform?

No matter the results of the November elections, one thing is clear: The health care industry is entering the next era of health care reform. Hospital and health system leaders must transform the delivery system to meet two profound and lasting market evolutions: population health and consumerism.

At this year's Health Care Advisory Board national meeting, we'll help you identify and prioritize the no-regrets investments that will support success toward these goals and more.

Register now to save your spot at a session near you.

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