Health Care: The Winning Closing Argument in a Tight Election

Presidential campaigns have long featured fierce debates over the future of the healthcare system. But not so this year. That should change. And the candidate who best grabs the issue is likely to become the next occupant of the White House.

First, healthcare is the key hidden issue of this campaign.

Perennial issues remain unsolved. The cost of the US health system continues to rise and now accounts for 18.2 percent of our country’s GDP, or more than $4.5 trillion. High deductible health plans mean that out-of-pocket costs are hitting consumers hard. Insurance premiums are about to significantly increase as the high cost of anti-obesity drugs are factored in. Our population is aging, with more people over age 65 than those under age 5. The public health system remains under-resourced and undervalued at the same time that we are dealing with a growing list of public health crises. The lines between public and private health insurance are becoming increasingly blurred as private for-profit managed care plans are responsible for the care received by most public insurance beneficiaries. 

Meanwhile, the healthcare marketplace is currently undergoing a massive transformation with new challenges to address: private equity ownership of hospitals and hospice’s, physician shortages prompted by stress and burnout, the role of telemedicine, retail health clinics replacing family practices, not to mention both the vertical and horizontal industry consolidation on a massive scale. Generative AI is running rampant in wearable health technology and is now a large part of precision medicine, despite little regulatory oversight. Patient privacy is becoming more and more detached from HIPAA’s safeguards.

Discontent with the healthcare system is a bipartisan issue.

In this context, the next president will shape the health care conversation by using the bully pulpit, by working with the next Congress, and by appointing 15 cabinet members, dozens of advisors, and hundreds of judges that will have serious influence over our health system.

So why the relative silence? For months, it’s only been broken by the attention paid to the right to an abortion in a post-Roe world, and by an occasional discussion of the ACA subsidies in need of renewal or by the complicated effort to reduce drug costs.

To be sure, part of the explanation is that former-President Trump has set much of the agenda with his relentless focus on immigration, inflation, and crime. Another factor is the Harris focus on demonstrating the danger of a second Trump administration.

But we were just exiting a recession when Bill Clinton proposed National Health Insurance in the 1992 campaign and when Barack Obama proposed major health reform in 2008. Similarly, Medicare is in no better fiscal shape today than it was in 1996 when Clinton and Bob Dole debated how best to protect the program’s financial future. And Donald Trump was railing against illegal immigration when he made repealing the ACA his top priority when running for office in 2016.

So, what’s different this year?

One factor is that because of the ACA, fewer than 8 percent of the US population remains uninsured. And it’s more difficult to gain political capital off some of today’s most critical healthcare issues. Calling for the renewal of ACA subsidies just doesn’t look sexy on a podium placard.

But as the campaign winds toward a too-close-to-call finish, both candidates seem finally to understand that health care could be a winning closing argument, as evidenced by the recent Harris proposal to expand Medicare coverage to include some home care services and by the recent push by Trump’s newest health care advisor, Robert Kennedy Jr., to “Make America Healthy Again.”

Neither candidate, however, has emphasized that the moment we get complacent with the state of the US healthcare system is the moment we see our country fail its populace.

Nor has either candidate emphasized that healthcare needs to be at the forefront of the political discussion.

We need more investment in medical research for new and worsening diseases. We need oversight of big tech companies breaking into the healthcare industry. We need to support our hospitals and promote access to timely care. 

The polls are clear that the election is up for grabs. The Harris campaign should use its proposal to expand Medicare as the first step in a planned focus on fixing the health care system. It also should push back against the notion that the path to a healthier America is through an attack on life saving vaccines. 

Bill Clinton and Barack Obama both realized the power and the importance of a focus on health care. No issue is more personal and more important. With just days to go in the current campaign, a greater focus on improving the nation’s health could well be the difference in a close election. It’s the issue that could break the tie.

Michael Sparer, JD, PhD, is Professor and Chair in the Department of Health Policy and Management at the Mailman School of Public Health at Columbia University.