February 3, 2016
Most standard questions aimed at presidential candidates in recent years have sought affirmation or denial of standard propositions. For example: Do you favor repealing or extending Obamacare? Would you ensure near-universal insurance coverage? Do we need more federal regulation or greater state-level discretion?
That or they try to generate advance signals about near-term tactics. For example: Should we increase or trim taxpayer subsidies? How much should price variation be limited or curtailed? Are coverage and care goals better achieved through regulatory mandates or market-like incentives?
However, this is getting well-worn and generic, if not a little hackneyed, for these questions tend to obscure more basic dividing lines between candidates, and how candidates are likely to think about health policy and frame any plans for future changes. Of course, our vast accumulation of laws, regulations, institutions, entrenched interests, vulnerabilities, and evidence-free assumptions constrain any sort of “blank sheet of paper” rethinking in this sphere of politics. But we might better predict how candidates will proceed if we ask them the following five questions:
Although many additional layers of complex calculations must be transferred or delegated to other parties in making health care purchasing and treatment decisions, the most important one that sets the table is: Who controls the money up front and then attaches strings on how others might receive it? In the United States, about 45% of all health care spending flows directly through government channels as outlays. Two major entitlement (automatic spending) programs – Medicare and Medicaid – account for most of that total.