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Let the Debates Begin


By Mark L. Horn, MD, MPH, Chief Medical Officer, Target Health Inc.


Whatever one’s political leanings, the selection of Representative Paul Ryan has the potential to be a ‘game changer’ in the campaign rhetoric. Happily, and once again irrespective of any individuals’ political views and absent gross negligence by the media, the impact will almost certainly be controversial, which is a positive, because it’s a driver of political discussion everywhere. We are already seeing the evidence.


With alacrity the news reports, Op-Ed pieces, Editorials, and commentary have begun to focus not solely on the ‘gaff’s de jour’: e.g., college transcripts, fancy horse steps, off-shore accounts, birth certificates, & generally silly comments, and instead to pay at least modest attention to the actual content of the candidates’ policy proposals. More specifically and importantly, the focus is on entitlements. Initially the attention is on the politically immensely sensitive Medicare program, but potentially (and hopefully) Social Security and Medicaid will follow. These discussions are timely, critical and cannot help but be salutary for our republic if even close to properly managed.


The key challenge is for the media. The debate will need to be chaperoned both to keep it reasonably civil, and more importantly, to assure that it is maximally instructive. Exaggeration and outright misrepresentation will doubtless occur, especially in campaign commercials, but if the media is responsible and does its job competently we can have a substantive discussion.


At present, the most detail regarding the divergent approaches exists for the Medicare program, so the campaigns will initially focus there. The parties clearly differ in their approaches to stabilizing the program and keeping it solvent as it absorbs the coming wave of retiring baby-boomers. However, the health care discussion is complex and will be expanded in scope by the impact of the Affordable Care Act which links changes in the Medicare Program to overall health system reform. Republicans appear committed to repealing the Act which necessarily raises issues of covering the uninsured and those with preexisting conditions, and mitigating lifetime payment caps. What are their practical alternative solutions?


These discussions will engage the public, broaden the debate, and if properly managed focus attention on proposals (or lack thereof) to solve critical problems addressed by the ACA.


So, irrespective of anyone’s feelings about Representative Ryan and his controversial voting record, like a lightening rod, his selection will create a substantive debate on issues impacting not just health care, but also national solvency. The country will in large measure rely upon our media to meet the challenge, appreciate the gravity of the situation, and seize this opportunity to educate the public. Paraphrasing NY Senator Daniel Moynihan’s much quoted observation “Everyone is entitled to his own opinion, but not his own facts”; the media is best positioned to assure that the coming debate is factually based, that numbers and figures are used to clarify and not obfuscate, and that parroted, rehearsed “talking points” designed to oversimplify and create public anxiety are effectively challenged.


If this challenge is met, the decision in November can reflect the considered decision of an informed public; that’s probably not what most expect but why not be an optimist? So, “Let the Debates Begin.”


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