Last week, the New York Times posted an online poll asking its readers to choose which three of 15 possible questions they'd like to see the candidates address during the debates, which kick off Monday night.
Only one touched on healthcare. That reflects the reality that the issue (so far) has just played a cameo in this year's general election campaign.
Here's their choice: “Health insurance premiums and out-of-pocket costs are rising rapidly. What would you do to control them?”
Not drug prices? Curious, given it's the No. 1 cause of rising costs. But let's not digress.
If I were advising a candidate on how to respond to that question, here's what I'd recommend he or she say:
“Thank you for that question, Lester. I understand why many Americans think their insurance premiums are rising rapidly. There's been a lot of attention paid to next year's increases for the individual policies sold on the Obamacare insurance exchanges, which will rise about 9% on average, according to the latest Kaiser Family Foundation survey.
“I'll get to why that's happening and what we can do about it in a moment. But we have to remember only 12 million people, most of them low or moderate income, get their coverage there.
“Half of all Americans—more than 150 million of us—get our coverage through our employers. And the good news there is that rate increases will be modest next year.
“Overall costs for employer-based coverage will go up just 5.5% in 2017, according to the Mercer September survey. That's not much different than what we saw over the five years since Obamacare passed. And it's significantly less than the 7% to 9% they went up in the decade before that.
“But something else is happening that is hurting families. Employers are forcing individuals to pick up more of the cost of their plans.
“The employer portion of your health insurance is going up just 4% next year on average. That means the family share has to go up more than 5.5% to make up the difference.
“Employers are doing that by putting more of us in high-deductible plans. They're asking more of us to pay higher co-pays and deductibles. They are raising our portion of the premiums.
“We can't blame the healthcare system or Obamacare for that.
“So what can we do about it? First, we have to recognize this is a big experiment that has been endorsed by economists associated with both political parties. They say by forcing patients and consumers to have more skin in the game, they will become wiser healthcare shoppers.
“I say, to make that work, we have to have total transparency—in healthcare prices, in insurance prices, in which doctors and hospitals are in health plan networks, in quality ratings, and with good, easy-to-understand information about what constitutes the most effective and cost-effective care. I pledge to work night and day to give consumers the information they need to make smarter choices in the healthcare marketplace.
“And if some people simply can't afford to put money into the health savings accounts accompanying these plans, let's remove some of the tax subsidies given high-income people for their health insurance so we can finance a generous federal match for what lower-income people contribute.
“Let me now turn to what can we do about those rising individual rates for plans sold on the exchanges. The bottom line is we need more people to sign up. The No. 1 reason why rates are rising is that not enough healthy uninsured people signed up for coverage.
“When President Obama took office, 16% of the population lacked insurance. Today that's down to 10%. That's great, but it is still 30 million people! We need everyone who is uninsured to jump into the individual insurance pool.
“That's how insurance works. When everyone pays in, there can be reasonable rates for everyone's routine and preventive care, and enough money to pay the very expensive bills for those who get cancer, suffer heart attacks or have other very expensive illnesses.”