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President's Perspective: Iowa Caucus on Healthcare: A Silent Cacophony

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with Ted Townsend, UnityPoint Health St. Luke's President & CEO

Talk about much ado about fairly little. We took a call the other day from a national media reporter wanting assistance on getting a story together about how the Iowa Caucus campaigns were focusing in on healthcare as a national issue.

We had little to share, primarily because the big healthcare issue in Iowa these days isn’t national healthcare policy, but the conversion of our state Medicaid program from a single state-managed system to one parceled out to three (maybe four) private, for-profit “managed care” companies that are claimed to improve access and care coordination while tripling provider’s administrative complexity and somehow reducing costs.

The Republican candidates stumping in Iowa shied away from the issue. It contained controversy, was supported by a Republican governor whose powerful presidential endorsement remains publicly idle on the sidelines, and its whole value as an issue limited to its indirect potential to bash the Affordable Care Act. While the ACA (erstwhile Obamacare) continues to bubble at the national level, it doesn’t seem to be nearly as hot an issue when benched up against terrorists, gun rights and which candidate can insult others with greater wit. Ethanol, Planned Parenthood, and oil pipelines all have seemed to outrank healthcare on their part of the partisan divide. The only candidate to even address it was Hilary Clinton and she limited herself to raising modest concerns about access to care for the poor.

Perhaps the congressional Republican’s recent success at putting repeal legislation on President Obama’s desk will re-ignite the issue, but right now it feels like a classic back burn, just enough to stop the real fire from getting too close. Pass repeal so you can tell your core constituents you’ve done all you can to do away with the ACA, knowing it will be vetoed, while the other side defends it as the law of the land but certainly open they say to improvement.

The tragedy of course is that this is allowing both parties to essentially dodge this critical issue in the Iowa caucus debates. I’ve always seen the critical purpose of the caucuses to be setting an initial tint to how purple the eventual national nominees for either party will need to be given Iowa’s penchant for being a potential red to blue or vice versa swing state. That alone makes Iowa a great state to test the tolerances of new ideas, reform concepts, or political trial balloons, but instead we have everyone trying to play to core constituencies that are the only groups that can be counted on to come out for primary votes, or caucuses, or both.

So I guess I can’t just blame the candidates for not talking more about healthcare. There isn’t much room for debate in the core constituencies of either party, but here’s the rub. Presidents need to be leaders, they need to lead us all, not one party, and whichever party wins the presidency needs to be giving serious thought to where do we go from here. Democrats need to be looking for common sense modifications to the ACA that will make our national healthcare policy more of a bipartisan effort and cost effective in the long run. Republicans need to be starting the process of legitimizing their complaints by offering thoughtful alternatives, a different approach to healthcare, to reform, since they weren’t happy with the system prior to the Affordable Care Act either, and it is intellectually dishonest to talk about repeal and reform without the least consensus within their own party about what that might look like.

Iowa would be a good place for both these political paths to take a major step forward, testing, teasing, trying to articulate a better way. It’s important work. It’s a wasted opportunity. It’s the way the system works. It’s an excuse. And I’m waiting to see which, if any, candidate or candidate can demonstrate the real presidential timber of actually acting like they know how to do that job.

Ted Townsend
President and CEO
UnityPoint Health Cedar Rapids