WASHINGTON — If the fourth Democratic presidential debate goes anything like the last three, the candidates will spar vigorously Tuesday night over how to get health coverage to more Americans.
But so far, in their fixation on how people obtain insurance, they have spent little time debating the skyrocketing costs for premiums, deductibles and medications that affect tens of millions of people who already have health plans.
That could be a missed opportunity. New research shows that Democratic-leaning voters actually want to hear more from the 2020 candidates about how to lower health care costs for everyone — not just get coverage to those who don’t have it.
A Kaiser Family Foundation poll released Tuesday found majorities of such voters feel the candidates have spent too little time talking about health care costs, surprise medical bills and reproductive health — and enough, or even too much, time discussing Medicare for all.
Among the poll’s findings:
— 58 percent of Democratic or Democratic-leaning voters said the candidates are spending too little time discussing women’s health care
— 52 percent said they are spending too little time on surprise medical bills
— 50 percent said they are spending too little time on how to lower the cost of health care
— 47 percent said they are spending too little time on the cost of prescription drugs
As 12 candidates take the stage at Otterbein University outside Columbus, Ohio, they’ll have yet another chance. Health care is an issue that got more airtime than any other topic (21 percent of all words spoken in all three debates combined, according to a Bloomberg analysis). Candidates have spent the first half-hour of each debate debating various iterations of Medicare for all versus the public option approach and whether to trash or keep employer-sponsored coverage.
While the discussions have been unusually detailed for a televised debate, the candidates have been criticized even by experts for having a relatively narrow focus despite a whole universe of ongoing and troublesome problems with how Americans access health care.
“They are arguing endlessly about the subsidiary question of ‘how’ universal coverage would be achieved: with or without the availability of private employer-based insurance,” Andy Slavitt, who oversaw the Affordable Care Act under President Barack Obama, wrote in a recent USA Today opinion piece.
“Americans need a bigger picture, and with President Donald Trump claiming that Democrats ‘want to take away your health care,’ they need a more accurate picture,” Slavitt wrote.
Discussions of Medicare for all and the public option are interesting and important, because they get at how to expand health coverage to the remaining 27 million Americans without it (although about half of them are already eligible for Medicaid or government subsidies to buy private plans).
But the polling reflects the ongoing struggle in the United States to make health insurance and prescription drugs affordable, problems Congress has said it wants to tackle this year. Both employer-sponsored plans, which cover 160 million Americans, and those available in the state-based marketplaces have suffered from rising premiums and increasingly steep deductibles.
Those problems won’t necessarily be solved even if universal health coverage is achieved. Even the 2010 health care law — the most sweeping health-care reform law in decades — didn’t bend the cost curve even as it expanded coverage to about 20 million people.
So some health policy experts are arguing the candidates would do better to focus on the cost of health insurance and prescription drugs for consumers and suggest ways to mitigate those costs.
“I tend to think the affordability point is more important than the coverage one,” said Bob Kocher, who worked on health policy issues at the National Economic Council under Obama.
In his opinion piece, Slavitt called on the Democratic candidates to lay out a vision for reforming health care payments so they encourage better-quality care, improving lagging maternal health, combating opioid abuse and encouraging healthy behaviors that reduce the need for care.
Several of the candidates, including Mayor Pete Buttigieg of South Bend, Indiana, and Sens. Elizabeth Warren, D-Massachusetts, and Kamala Harris, D-California, have laid out health care proposals that go beyond just how to expand health coverage.
But whether the candidates go beyond their differences over Medicare for all in Tuesday night’s debate remains to be seen.