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In: Opinions & Features

10.7.16 | Forbes.com

By Steve Brozak

To read the entire article on Forbes.com, please click here.

As the election draws closer, issue polls consistently rank healthcare affordability at or near the top of American voters’ concerns. In fact, a Kaiser Foundation Health Tracking Poll in August found that two-thirds of Americans are worried about the future of Medicare and the costs of healthcare and medicine.

But these issues weren’t raised in either the first presidential debate between Hillary Clinton and Donald Trump, or in the recent vice-presidential candidates’ debate.

Let’s hope that this coming Sunday’s debate between Clinton and Trump gets right to these issues that worry voters.

Here are five questions on healthcare Sunday night’s town hall audience should ask Clinton and Trump:

1: One of the nation’s largest insurers, Aetna, recently announced it was pulling out of Obamacare because the costs for the company were increasing too much, too fast. Aetna identified some $430 million in losses on ACA-based policies, though such losses apparently haven’t hurt Aetna’s share prices. Meanwhile, patients with Obamacare face steep premium increases.

Do you think Obamacare is sustainable? What would you do to incentivize major health insurance companies to join and/or stay in the ACA system? What would you replace Obamacare with, if you think it is unsustainable, and how would you implement your plan?

2: Mylan N.V., a major generics manufacturer, has increased the price of its EpiPen, a portable injector containing life-saving medicine to treat anaphylactic shock, from about $95 in 2007 to over $600 today for a two-pack. The EpiPen represents about 10% of Mylan’s revenue and 20% of its operating profits.

Parents are rightly panicked that their children highly allergic to bee stings, peanuts and a host of other items will not have the quick-shot EpiPen when they need it most because it’s too expensive to carry around. In the midst of the uproar over cost, CMS said that Mylan overcharged Medicaid on EpiPens’ costs for years. Some estimates suggest rebates to Medicaid should have been at least 10% higher. There could be major fines and other repercussions, say Capitol Hill lawmakers. What would you recommend to prevent another EpiPen crisis? What would you recommend as a resolution to the alleged overcharges by Mylan?

3: The planned merger of Pfizer and Dublin-based Allergan fell apart this year under government scrutiny and warnings by lawmakers about Pfizer’s plan to use an inversion with Allergan to avoid U.S. taxes. (Don’t worry: I’m not talking about anyone’s tax returns.)

Do you think the proposed Pfizer-Allergan merger was anti-consumer? Do you think mergers in the pharmaceutical industry are good business? Meanwhile, the government is pondering a proposed merger between two of the nation’s insurance behemoths.

Is such concentration in the healthcare industry good for consumers? If not, how would you propose stopping such moves, and what do you think the fallout on the markets would be?

4: While the presidential election has pharma’s attention, there’s a less-publicized issue that California residents are about to vote on called Proposition 61. It’s a convoluted, controversial ballot initiative to control the costs of prescription drugs by linking their prices to the lower prices paid by the Veterans Administration. However, the proposition could gain immense steam, and even if it might not be legally enforceable, other states may adopt similar measures as a way to protest rising drug prices. One of the poster children for the pro-Prop 61 campaign is the drug Sovaldi, made by a Golden State company, Gilead Sciences. Sovaldi is essentially a cure for deadly Hepatitis-C. It’s also one of the most expensive drugs in America, and has made Gilead the bane of Medicare, Medicaid and prison systems across the country because of its cost.

What do you think of Proposition 61? Should state agencies be allowed to cap the amount they pay for drugs and refuse to pay the market price demanded by the maker? Why is the state of California taking the lead in this instead of the federal government?

5: More companies are adopting what is being sarcastically called the “Valeant business model.” Instead of investing in R&D, Valeant was growing by buying up rights to old, cheap drugs that had few manufacturers, and hiking their prices by several hundred percent. That’s legal, but another drain on the healthcare system and on patients. Can, and should, the government try to stop such business moves? How would you create competition in the older-drug market? What would you recommend to incentivize pharmaceutical companies to put more money into R&D for innovative drugs?

And here’s a bonus question: Most of the major blockbuster drugs of the last 20 years, including several critical cancer treatments, were begun with government-funded basic research. Given the crucial need for government support, where will seed money come from to continue the funding of this important research?

Questions like these would serve as a good basis to start a discussion on healthcare; however, given the lack of substance of the previous two debates and the current state of discourse in America, audiences should be surprised if even a single meaningful question on healthcare is asked.  If one is asked, we should be equally surprised if it is adequately addressed beyond canned talking points.