Shorter days, school buses and crisp mornings signal the return of fall, as well as our approaching midterm elections. Just as we prepare for this new season with great anticipation, we also must prepare for the upcoming elections. The best way to do so is to develop a set of questions for all of our national, state, county and local candidates, irrespective of party, and to pose the questions to each of them.
Because of the recent catastrophic threats to healthcare in Congress, it will be very important to know where each of these candidates stands on the key issues that will influence our capacity to deliver good health, behavioral health and public health care in the future. Toward this end, I provide the following essential questions to be asked of each candidate.
What do you see as the future of Medicaid? It is very clear that the entire system of Medicaid health insurance, including the state Medicaid expansions, is essential for those who are disabled and poor. Hence, funding should not be reduced, and the program should not be converted to a block grant, or otherwise undercut.
What about the future of health insurance delivered through the state health insurance marketplaces? This health insurance program is essential for those who are near-poor and who do not have health insurance available through other sources. Further, the subsidies for insurance deductibles and care delivery provided through this program are equally essential.
Do you value an expansion of behavioral healthcare? Behavioral healthcare is an essential component public and personal health care that should be available to every American. It should include not only treatment and rehabilitation, but also prevention and promotion. Behavioral healthcare requires expansion because 85% of our counties have either inadequate or no care; most of these counties are rural.
Will you prioritize improved funding for community behavioral healthcare services? To each of us, it is painfully obvious that community behavioral healthcare is dramatically underfunded, and has been so for many decades. The solution to this dilemma is not to build more hospital beds or inpatient units in our city and county jails, but rather to develop those components of community care that can obviate the need for hospitalization.
Will you support an integrated healthcare model? The future lies in integrated care, not in the separate systems designed a half-century ago. Most people with behavioral health conditions have chronic physical diseases. We need good technical assistance and financial resources to make the transition to this new world.
I encourage you to attend candidates’ political rallies this fall, to phone in to candidate forums when opportunities present themselves, and to actually visit candidates in their offices. Ask them the hard questions. If we all do this carefully and consistently, we are much less likely to be shocked by what our elected official propose and undertake in 2019.