Health Care: The Lost Issue of Presidential Election 2016

A Q & A with five leading experts on what the next president must do to meet America’s unmet health needs.

If you blinked—you missed it. For about two minutes, health care was a topic in the third and final 2016 presidential debate. The brief, contentious exchange, did nothing to highlight many of the tough challenges Americans face when trying to keep themselves and their families healthy.

Here’s what five of The New York Academy Medicine’s Fellows Ambassadors—renowned experts in primary care, medical ethics, population health, and other critical fields—say the next administration needs to do offer Americans better care.

Put Population Health above Politics

Patricia Schnabel Ruppert, DO, MPH, Rockland County Commissioner of Health, Lecturer, New York Medical College

Q: You protect the health of an entire county. What population health issue should be at the top of the candidates’ agenda?

A: We are most in need of a swift, federal response when we face an infection or potential pandemic.

 In 2009, for example, the H1N1 virus affected millions of people. Two years later, the U.S. spent $5.4 billion to tame Ebola.  

Yet, in 2016, as the Zika virus began threatening not only infant health through microcephaly, but also adult brain health, Congress adjourned without passing a $1.8 billion fund to fight the virus.

Regardless of who wins the election, there is a pressing need for an emergency fund for public health. The existing fund was created in 1983 with $30 million, but Congress has now allowed the Fund’s reserve to shrink to approximately $57,000. We need a fully-funded, rapid-response reserve dedicated to threats to the public’s health.  

Get Serious about Oral Health

Nadia Laniado, DDS, MPH, Director, Community Dentistry and Population Health, Jacobi Medical Center

Q: Dental care is always a campaign topic, but millions are still without care. What do we need from the federal government?

A: The candidates have at least one thing in common—they can afford good dental care, but that makes them rare in their age group. More than 100 million Americans are without dental coverage, including more than 70 percent of older adults (Medicare does not cover routine dental care). The American Dental Association also reports that only about 35 percent of working adults utilize dental care, because many do not have private coverage or see other financial barriers to care.

All of this leads to increased tooth loss and gum disease at a time when research links poor oral health with inflammatory conditions such as diabetes and cardiovascular disease. Without good oral health you cannot have good systemic health---it is time for the government to put its money where our mouths are. People need better coverage.

Don’t Leave Our Wounded Vets Behind

Joseph J. Fins, MD, MACP Chief of the Division of Medical Ethics at Weill Cornell Medicine and author of "Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness”

Q: Have the candidates adequately addressed care for people with traumatic injuries?

A: If I had five minutes with the next president, I’d tell her or him not to forget the more than 300,000 veterans with traumatic brain injury—the “signature injury” of the wars in Iraq and Afghanistan. I’d cast this as a moral obligation, and if I had the time, I’d quote President Lincoln’s solemn promise “to care for him who shall have borne the battle…” High minded language, yes, but this is a sacred trust and national obligation, where we have fallen short.

Fortunately, there is an excellent roadmap to better meet the needs of those who have borne the battle in the Final Report of the Commission on Care mandated by Congress through the Veterans Access, Choice, and Accountability Act of 2014.     

It is important that the pragmatic and strategic recommendations offered by the Commission are not lost as we transition to a new administration. I’d like to believe that we can come together in a bipartisan fashion to meet the needs of our veterans.                             

Understand Mental Health and Gun Violence

Joseph P. Merlino, MD, MPA, Vice President for Faculty Affairs and Professional Development and a Professor of Psychiatry at SUNY Downstate Medical Center 

Q: Are the candidates showing a full understanding of behavioral health on this critical population health issue?

A:  The current administration’s budget calls for a $500 million investment in mental health care as a method of addressing our national epidemic of gun violence. There’s no doubt we need more funding for behavioral health care, but this approach shows a lack of understanding of both issues. Our leaders must address gun violence without stigmatizing millions of innocent people because they are mentally ill.

The next President and Congress must recognize that most mentally ill individuals do not commit violence, but are actually 10 times more likely to be victims of violence.

Fewer than 5 percent of the 120,000 gun-related deaths in the United States between 2001 and 2010 were caused by people with mental illness. The latest research also explains that restricting firearm access, based on mental health status, is not an effective gun violence prevention strategy.

Linking gun violence prevention legislation and mental health care puts yet another barrier between mental health care and those who need it.

Make Health Literacy a Real Priority

Q: With such a long list of health needs, why should the next president be thinking about health literacy?  

Terri Ann Parnell DNP, RN, FAAN, Principal, Founder, Health Literacy Partners, LLC; and author of “Health Literacy in Nursing: Providing Person-Centered Care”

A:October is Health Literacy Month—an important time to note that only 12 percent of American adults have the skills needed to manage their own health. Studies have found a connection between lower health literacy and poor health outcomes and preventable hospital admissions. 

As the candidates battle about the ACA, they should also be concerned with whether people can understand the ACA’s complexities such as eligibility, covered services, deductibles, copayment, and open enrollment.

Part of the solution is The National Action Plan to Improve Health Literacy (NAP).  It promotes two key principles—first, everyone has the right to health information that helps them make informed decisions.  Second, health services should be delivered in ways that everyone can understand. This is the next step toward building a health literate society.

Cost is Still the Issue!

Mark P. Jarrett, MD, MBA, Senior Vice President & Chief Quality Officer, Northwell Health
Professor of Medicine Hofstra Northwell School of Medicine

Q: Each candidate has promised to change the ACA to address consumer out-of-pocket costs. What do they really need to know to effectively shape new legislation?

A:  The number of uninsured Americans is at about 10.5 percent, the lowest in decades. Yet, millions of adults are still underinsured or unable to afford care even if they have coverage.

Most consumers are now paying more of their health care costs than ever before. At least 15 percent of families recently surveyed by Consumer Reports say that paying for health care is their greatest concern.

Many who can see a physician still can’t afford prescribed medication because they may paying up to 25 percent more for brand-name prescriptions. We are constantly hearing about new and highly-effective treatments, but sometimes at a cost of $15,000 or more a year.

A recent Rand analysis shows that both candidate’s proposals would still leave consumers in the individual market with thousands of dollars of out-of-pocket care costs. As a nation, we must address this effectively or we will never see expanded coverage translating into improved health across the population.