BLOG: Optometry and the presidential debates

Summertime is upon us once again. It seems to happen every year about this time.

This year, summer vacation has a special treat above the warm days and fun in the sun. We have the opportunity to watch and digest the presidential debates.

As primary health care providers, we may not have been involved with day-to-day political rhetoric or geopolitical issues, but this year the future of the health care system is at the heart of the discussion.

These are not your typical presidential debates. It seems that the popularity of reality television has affected the process, as we have almost as many suitors for the big job as the bachelorette has for her hand in marriage. Being a big fan of both, I can tell you that the fireworks and drama are about the same.

Health care is the top issue for voters, according to a recent Gallup poll. Eighty percent of Americans rate it as extremely important or very important in their decision for whom they should cast their vote.

Yet the issue is so complex that the discussion alone is confusing. In the previous election, the Republican party ran hard to repeal and replace the Affordable Care Act (ACA). Yet, in spite of winning the presidency and both Houses, they failed to find a viable alternative.

This time, the buzzword is “Medicare for all.” This seems simple on first glance, as Medicare is a popular program for seniors and has been around since the mid-1960s. Yet Medicare is health insurance, not an HMO. As such, it does not include wellness and preventive care. It did, however, add a one-time “wellness visit,” and this is thanks only to the ACA. But this is not a physical exam and is underutilized and confusing to patients (Andrews). It also does not cover any testing or preventive measures. Medicare for all is also prohibitively expensive. It is estimated to cost between $28 and $32 trillion over 10 years and would do little to improve the health of our nation.

Although most of the Democratic candidates agree that the nation needs to expand health care for more people, they do not all endorse Medicare for all. The field is pretty well split over the issue, with 59% supporting some form of Medicare for all, and 41% supporting “something else.” In the something else category are things like updates and revisions of the ACA and a bill introduced in the House in 2018 known as Medicare for America. This bill would expand Medicare to the uninsured and make it an option for those unhappy with their current health coverage.

These are important distinctions and could make a big difference on who will ultimately be elected as the next president. Optometrists, as both health care providers and health care consumers, need to be knowledgeable about these different programs and be ready to discuss them in a thoughtful way with friends, colleagues and patients.

I have long been a fan of revisions and updates to the ACA. This is a hybrid of government and private health care and has stood the test of time. It certainly needs work, and changes made by the current administration have weakened it rather than made it better. Yet it remains the law of the land and has enrolled 8.5 million people.

After many years as a member of an HMO, I signed up for traditional Medicare last year. No more co-pays, no more need to stay in network, after years of health care premiums, I was finally a ward of the state. Then came the sticker shock. The cost of the secondary coverage didn’t seem too bad, but then came bill for the main coverage. Since I am still working, the premium rate was staggering, much more that I had been paying for my HMO plan. Well, at least I had full coverage. Not exactly. As I am not sick, very little is covered. Again, this is health insurance and not the preventive and wellness-based care that I have long enjoyed.

I can’t wait to get back on an HMO by enrolling in a Medicare Advantage Plan. I am not alone; 20 million Americans have enrolled in these plans. The number grows every year and now represents over one-third of all Medicare subscribers. So, for me and a growing number of us who have tested the water, the elimination of private payors and Medicare for all is not a viable alternative.

I urge all my colleagues to carefully watch the debates and do your own research and fact checking. Once you are knowledgeable, you can help those who may not be a part of the system understand the issues so we all can make an informed decision on election day.

References:

Andrews M. Costly confusion: Medicare’s wellness visit isn’t the same as an annual physical. Kaiser Health News. Posted March 20, 2019. Accessed July 17, 2019.

How much will Medicare cost for all? Committee for a Responsible Federal Budget. Posted February 27, 2019. Accessed July 17, 2019.

Jacobsen G, et al. A dozen facts about Medicare Advantage. Henry J. Kaiser Family Foundation. Posted November 13, 2018. Accessed July 17, 2019.

Newport F. Top issues for voters: Health care, economy, immigration. Gallup. Posted November 2, 2018. Accessed July 17, 2019.

Scott D. Obamacare sign-ups surge in final tally. Vox. Updated December 21, 2018. Accessed July 17, 2019.

Uhrmacher K, et al. Where 2020 Democrats stand on Medicare for all. The Washington Post. Updated July 15, 2019. Accessed July 17, 2019.