Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

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.