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Risks in ‘Full’ Disclosure of Presidential Candidates’ Health Records

In this Wall Street Journal Think Tank column, Drew Altman discusses the risks of full disclosure of presidential candidates’ health records, and considers a possible solution to the problem.

Column/Op-Ed Read Post

The ACA Marketplace Problems in Context (and Why They Don’t Mean Obamacare Is ‘Failing’)

In this Wall Street Journal Think Tank column, Drew Altman discusses the latest challenges faced by the Affordable Care Act (ACA) marketplaces and why they should be kept in perspective: “If Obamacare had bipartisan support, they would be treated much more like mundane implementation issues to be addressed by Congress than glaring headlines about Obamacare failure.”

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How Donald Trump’s Assertions About Obamacare Premium Increases Can’t Be True

In this Wall Street Journal Think Tank column, Drew Altman discusses why Donald Trump’s campaign trail claim that the Obama administration is withholding big Affordable Care Act premium increases until after the election to influence the outcome could not be true.

Column/Op-Ed Read Post

In La. and Ky. Shifts on Medicaid Expansion, a Reminder of Governors’ Power in Health Care

As the 2016 presidential election garners much attention, Drew Altman, in his latest Wall Street Journal Think Tank column, examines how down ballot races – especially governorships – can make a huge differences for health policy.

Column/Op-Ed Read Post

Public Misperceptions About Obamacare Premium Increases

In this Wall Street Journal Think Tank column, Drew Altman looks at the debate about increases in Obamacare premiums and public misperceptions about who is and is not affected by them.

Column/Op-Ed Read Post

In Wake of Dallas, Minnesota and Baton Rouge Shootings, an Opening for Local Leaders

In this The Wall Street Journal Think Tank column, Drew Altman discusses how incidents in Dallas, Baton Rouge and Minnesota create opportunities for local leaders to take steps to reduce police-involved violence, citing data from the KFF-CNN survey of Americans on Race and KFF-New York Times Survey of Chicago Residents.

Column/Op-Ed Read Post
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This was published as a Wall Street Journal Think Tank column on September 13, 2016.
Much has been said, and speculated, about Hillary Clinton’s health recently, including well before it was known that her doctor had diagnosed pneumonia last week. The New York Times and the Washington Post, among others, have called for presidential candidates to be more transparent about their medical records. It’s worth noting, as more information comes out and as more is sought, that full disclosure of medical records would almost certainly cause more harm than good. Serving up certain details of any candidate’s health, and past life, in a voracious social-media environment in which some elements of the media focus on “gotcha!” journalism and opponents leap to make attack ads has the potential to focus disproportionate attention on a candidate’s health–rather than a person’s readiness to govern and her or his positions on major issues. It makes sense that voters need to know whether candidates have a documented medical problem that could compromise their ability to serve as president or prevent them from completing their full term in office. That said, it seems possible to devise a formal system that both major parties could buy into, ensuring that such information is produced, rather than imploring individual candidates to produce it themselves.
 It’s easy to see the argument for disclosure if a presidential candidate has, say, serious heart disease or cancer, conditions that could affect one’s ability to serve. Now imagine the frenzy on social media if a candidate’s medical records indicated an episode of depression years before, or a sexually transmitted disease, or whether a male candidate uses Viagra, or if a candidate of either gender had been abused. These are points that understandably involve privacy. Full disclosure would tilt the spotlight to these issues, probably setting off long discussions on cable news about whether such issues should even be discussed. Not that long ago, well before the advent of social media and 24/7 cable news coverage, Thomas Eagleton was forced off the Democratic ticket after revealing that some of his past treatment for depression had involved electric shock. Imagine the constant focus on such information today.
The New York Times editorial seemed to suggest that Mr. Trump and Mrs. Clinton’s ages signify a special need to know all of their medical records: “Now Americans are deciding between Mr. Trump, who is 70, and Mrs. Clinton, who is 68. Whoever prevails will have to deal with round-the-clock demands, so it seems entirely relevant to inquire about their medical histories and current health.” Well, a healthy 48-year-old president could drop dead of a heart attack while jogging. It seems not far-fetched to suggest that unless a candidate has a known debilitating or potentially life-threatening medical condition, the American people would base their vote on other grounds–and take their chances on a candidate’s health in office, mindful always of who the vice presidential nominee is and that person’s ability to serve if needed. John F. Kennedy was the youngest person ever elected to the U.S. presidency, and he had serious health conditions. How might his close race against Richard Nixon have been affected by social media focus on his physical health? The Washington Post editorial said that “The goal must be to assure voters that they have disclosed anything that could hinder them while in office or create a risk that they could not serve a full term.” To meet this objective in future presidential elections, candidates from each party could agree to answer two medical questions: Do you have a medical condition that would compromise your ability to serve in office; and, if so, what is it? And, do you have a medical condition that might result in your being unable to complete your term in office; and, if so, what is that condition?
The answers to these questions along with their medical records could be submitted to a panel of three former surgeons general of the U.S. (or a similar group). Candidates could, of course, disclose more information if they wished to. This could be done soon after candidates are nominated so that a late-breaking health revelation does not unduly influence election results. Having an authoritative, objective panel certify the answers would be a way to identify problems if any exist without potentially making public decades’ worth of private information. The physicians on such a panel would have the ability to exercise medical judgment if needed and would be pledged to confidentiality. Even a panel of surgeons general may not quell the conspiracy theorists who will always be out there, but such a system could satisfy serious media and voters would have the information they need on candidates’ health without information that could both violate candidates’ privacy and distract from the larger issues at stake in U.S. presidential elections.
[post_title] => Risks in ‘Full’ Disclosure of Presidential Candidates’ Health Records [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses the risks of full disclosure of presidential candidates’ health records, and considers a possible solution to the problem. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => risks-in-full-disclosure-of-presidential-candidates-health-records [to_ping] => [pinged] => [post_modified] => 2017-02-06 13:53:48 [post_modified_gmt] => 2017-02-06 18:53:48 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=197362 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 195896 [post_author] => 71503784 [post_date] => 2016-08-29 16:55:15 [post_date_gmt] => 2016-08-29 20:55:15 [post_content] =>
This was published as a Wall Street Journal Think Tank column on August 29, 2016. 
Problems in the Affordable Care Act marketplaces are the big story in health care, spurred by Aetna’s pullback in participation. With headlines questioning whether these problems mean the ACA is “failing,” let’s take a step back for perspective. The marketplaces have a special role in health insurance, and they face real challenges, but they are a modest part of the overall insurance system. They are also only one part of the ACA–if an important part–and they are not having trouble in all states. First, there absolutely are problems in the marketplaces. Premiums will rise much more rapidly next year than they did this year. As the Kaiser Family Foundation’s analysis for the Wall Street Journal story published this week shows, in almost a third of counties–31%–marketplace enrollees may have a choice of only one plan next year. This will affect about 19% of enrollees, primarily in rural areas, and is a substantial increase from this year. But the administration is right to point out that the vast majority of enrollees will be insulated from premium increases by government subsidies if they enroll in one of the lowest-cost plans available in their area. Still, some enrollees who receive partial or no subsidies cannot afford coverage. President Barack Obama recognized that this month in his Journal of the American Medical Association article on the law, which called for Congress to increase financial assistance for this group.
 dawsj82916
Second, the marketplaces fulfill a vital role in the health system: replacing the previously broken non-group insurance market where many people could not get coverage if they were sick. But they are far from the only means through which most Americans get their health coverage. About 11 million people are enrolled in the marketplaces. More than 13 times that many, around 150 million, have coverage through employers, and there are 66 million people in Medicaid and 55 million in Medicare. All the debate and many news stories about the marketplaces may have given Americans the mistaken impression that problems in the marketplaces affect them when they will not. For example, many people with employer coverage believe that they are affected by premium increases in the marketplaces when they are not.
The marketplaces are an important part of Obamacare. However, more uninsured people have been covered by Medicaid expansions than in the marketplaces, even though 19 states have not expanded Medicaid. Millions of young adults have been covered on their parents’ employer plans. The law’s insurance reforms, including protections for people with pre-existing conditions, apply to people buying their own insurance outside the marketplaces as well (though so do bigger premium increases coming in 2017, and people buying coverage on their own outside the marketplaces cannot get subsidies). A broad range of ACA reforms in Medicare payments to doctors and hospitals are moving ahead and shifting reimbursement incentives in a better direction, regardless of the issues in the marketplaces. Many of these elements of the ACA are working imperfectly and can be strengthened, just like the marketplaces. But recent talk of “Obamacare failing” seems to conflate the marketplaces with the ACA overall. It’s hard to call the entire law, which covered 20 million more people and reformed insurance rules, a failure. And though the marketplaces face serious challenges, particularly in some states, there are areas where they’re working well and some insurers are earning profits on that segment of their business. The marketplaces do rely on private insurers to work, and those insurers have to be profitable if they’re going to stay in the market. Ultimately marketplace enrollment needs to grow. A Kaiser analysis suggest that enrollment could peak at just over 16 million, which is less than was originally projected by the Congressional Budget Office (21 million) but still robust enough to stabilize growth in premiums. There are also ways to boost enrollment and interest more insurers in participating, if Congress and a new administration choose to work together on such improvements. The issues in the ACA marketplace are real problems that need to be addressed through greater enrollment and policy changes. But if Obamacare had bipartisan support, they would be treated much more like mundane implementation issues to be addressed by Congress than glaring headlines about failure.
[post_title] => The ACA Marketplace Problems in Context (and Why They Don’t Mean Obamacare Is ‘Failing’) [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses the latest challenges faced by the Affordable Care Act (ACA) marketplaces and why they should be kept in perspective: “If Obamacare had bipartisan support, they would be treated much more like mundane implementation issues to be addressed by Congress than glaring headlines about Obamacare failure.” [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-aca-marketplace-problems-in-context-and-why-they-dont-mean-obamacare-is-failing [to_ping] => [pinged] => [post_modified] => 2017-02-06 13:53:22 [post_modified_gmt] => 2017-02-06 18:53:22 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org?p=195896&post_type=perspective&preview_id=195896 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 195372 [post_author] => 36621681 [post_date] => 2016-08-14 14:49:19 [post_date_gmt] => 2016-08-14 18:49:19 [post_content] =>
This was published as a Wall Street Journal Think Tank column on August 14, 2016. 
There has been a lot of discussion recently about Obamacare premium increases. Donald Trump has weighed in–accusing the Obama administration of concealing big premium increases in the Affordable Care Act marketplaces and delaying them until after the election to influence the result. Here is a breakdown of how Mr. Trump’s assertion cannot be true: Mr. Trump said on Aug. 10: “The big increase is now going to come on November 1. And they’re trying to delay it until after the election, because it is catastrophic. It is going to be an increase like never before. I’m hearing numbers that I don’t even want to say because the press will say, Oh, that’s terrible, he exaggerated. It’s not going to be an exaggeration. It’s going to be election-changing. And we can’t let those numbers be released on another date some time after the election, because it will show what a total disaster Obamacare is. So important.” ACA premium increases have become a topic on  the campaign trail–and voters should know that there is no way the administration can delay the ACA marketplace premium increases until after the election.
 Consider, first, that we already have a good sense of what the 2017 premium increases will be. Proposed rates have been submitted; the Kaiser Family Foundation and others have analyzed them. As the graphic below shows, the average increase for the commonly selected benchmark “silver plan” in the major cities in states where full rate information is available is 9%. That’s a steeper increase than we have seen in recent years, but that may be because insurers are making a one-time adjustment to a variety of factors. The size of rate increases also varies considerably around the country. We will have to see the 2018 increases to determine whether it is a short-term correction or a longer-term problem. Most consumers–83%–receive subsidies and don’t pay the full increases.
Recall also that rate increases are submitted by private insurers to state insurance departments. The Obama administration does not control the insurers or the state insurance regulators even if an insurer has a plan listed on the federal ACA marketplace through HealthCare.gov. Finally, the next open-enrollment season for marketplace plans–the ones whose premium increases already are generally known–begins on Nov. 1. That’s a week before Election Day, Nov. 8. All premiums will be public at that point. So there is no possibility of concealing rates until after the election. The only thing that could change the timeline is a delay in open enrollment, and there is no reason to expect that. In politics today–and this presidential election campaign in particular–facts, talking points, and wishful thinking have converged in speeches and statements. I do not pretend to know where the lines are drawn. Many people on the right and on the left have fact-based and principled criticisms of the Affordable Care Act that are not based on spin and exaggeration. But the Trump claim that the administration is concealing giant marketplace premium increases until after the election is a lot like the old claim that there were “death panels” in the ACA. It isn’t true. In this case it can’t be true. The question is how much the repeated assertions, even of falsehoods, will stick.
[post_title] => How Donald Trump’s Assertions About Obamacare Premium Increases Can’t Be True [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses why Donald Trump’s campaign trail claim that the Obama administration is withholding big Affordable Care Act premium increases until after the election to influence the outcome could not be true. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-donald-trumps-assertions-about-obamacare-premium-increases-cant-be-true [to_ping] => [pinged] => [post_modified] => 2017-02-06 13:46:07 [post_modified_gmt] => 2017-02-06 18:46:07 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=195372 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 194743 [post_author] => 36621681 [post_date] => 2016-08-03 07:22:20 [post_date_gmt] => 2016-08-03 11:22:20 [post_content] =>
This was published as a Wall Street Journal Think Tank column on August 3, 2016.
Kaiser Family Foundation map showing the status of Medicaid expansion decisions across the 50 states.
Two southern states, Louisiana and Kentucky, have reversed positions on Medicaid expansion–after electing new governors. This shift is a reminder, as the presidential contest draws so much focus, that down-ballot races also matter. When it comes to health policy, governors can make a huge difference. In Louisiana, former Gov. Bobby Jindal was perhaps the nation’s foremost opponent of Medicaid expansion. His successor, John Bel Edwards, made expanding the program a central plank of his election campaign. Mr. Edwards implemented the expansion by executive order, arguing that expanding Medicaid under the Affordable Care Act, and the federal funds that come with doing so, would cover hundreds of thousands of uninsured residents and take a big bite out of a large state budget deficit. Other governors, too, have changed direction. Democratic Gov. Tom Wolf in Pennsylvania replaced the more conservative plan of his Republican predecessor with a conventional expansion under the ACA. In very red Alaska, the independent governor, Bill Walker, forced a Medicaid expansion on a resistant legislature. In Kentucky, Gov. Matt Bevin was elected after loudly promising to scrap the Medicaid expansion launched by his predecessor, Steve Beshear. That expansion–along with Kentucky’s state insurance marketplace (Kynect)–is regarded by many as one of the most effective in the country. Mr. Bevin backed off his plan to scrap the Medicaid expansion but has since told the Obama administration that he would scrap the expansion unless the U.S. Department of Health and Human Services approves a waiver allowing Kentucky to institute a number of conservative policies that HHS officials may conclude are inconsistent with the Medicaid statute or potentially harmful to the health of low-income people.
As the chart above illustrates, the contrast between Louisiana and Kentucky, two Southern states, is sharp. Louisiana rapidly enrolled 250,000 uninsured people by July 15, using a streamlined eligibility and enrollment system that, among other measures, deemed people who are eligible for the Supplemental Nutrition Assistance Program (SNAP) automatically eligible for Medicaid. In Kentucky, by contrast, if Gov. Bevin and HHS officials do not reach agreement on a waiver plan and he follows through on his threat to abandon the program expansion, 449,000 residents would  lose coverage. Some–a minority–might regain coverage through less comprehensive, more expensive plans on the state’s ACA marketplace. Mr. Bevin is channeling his opposition to the ACA into a more conservative approach to Medicaid. Depending on how HHS responds to his demands for a waiver, time will tell if this position, like his earlier campaign rhetoric, is a negotiating tactic on which he does or does not follow through. There are 12 gubernatorial elections this year, three in states that have not expanded Medicaid: Missouri, North Carolina, and Utah. Two other states are scheduled to elect new governors in 2017 (New Jersey, which has expanded Medicaid, and Virginia, which hasn’t). The remaining 36 states have gubernatorial elections in 2018; so far, 14 of those are non-expansion states. Among those poised to hold elections in 2018 are Texas, Florida, and Georgia, the three non-expansion states with the largest populations of uninsured residents. Republicans are likely to retain most of the governorships in non-expansion states, but several Republican governors–including, notably, John Kasich–have expanded Medicaid. It’s unclear how new Republican governors may feel about Medicaid expansion in 2018, well after President Barack Obama has left office, when the ACA is a more settled matter in Congress (one way or the other), and when they know that the federal government will pay 90% of the costs of the expansion over time. Governors take on a variety of health-care issues, and many–including opioids, the Zika threat, and health-care costs–are pressing. Governors’ powers vary across the country, and they cannot always force a reluctant legislature to act. But as events in Louisiana and Kentucky are showing, there is a lot at stake in health care in down-ballot races in this and coming election cycles.
[post_title] => In La. and Ky. Shifts on Medicaid Expansion, a Reminder of Governors’ Power in Health Care [post_excerpt] => As the 2016 presidential election garners much attention, Drew Altman, in his latest Wall Street Journal Think Tank column, examines how down ballot races - especially governorships - can make a huge differences for health policy. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => in-la-and-ky-shifts-on-medicaid-expansion-a-reminder-of-governors-power-in-health-care [to_ping] => [pinged] => [post_modified] => 2017-02-06 13:51:08 [post_modified_gmt] => 2017-02-06 18:51:08 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=194743 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 193581 [post_author] => 36621681 [post_date] => 2016-07-15 14:30:24 [post_date_gmt] => 2016-07-15 18:30:24 [post_content] =>
This was published as a Wall Street Journal Think Tank column on July 15, 2016.
“Limited empirical validation” is a fancy social science term for using an anecdote to make a broader point that is not actually supported by the evidence. That’s what Donald Trump did recently at a campaign event when he touted a proposed 60% increase in Blue Cross premiums in the Affordable Care Act marketplace in Texas. This was accurate. Mr. Trump also predicted further huge increases, timed for after the election, that he suggested would lead to the downfall of the ACA. News reports across the country are mentioning outsize proposed premium increases from some plans in some marketplaces. Many news reports have been careful to say that these outsize increases are not typical, nor the whole story. But there is a wider misperception about Obamacare premium increases: Many Americans insured through their employers wrongly believe that these large premium increases apply to them though only a much smaller group is affected. As the chart above shows, more than 80% of Americans have heard or read news reports about premium increases that have focused on proposed increases in the ACA marketplaces. Sixty-eight percent think those increases apply to all insurance plans or to employer plans, through which 154 million Americans get coverage. In fact, they apply only to the ACA marketplace plans, through which about 11 million people are enrolled. Just 10% of the public understands that the increases they were hearing about apply only to marketplace plans.
Every year health premiums go up by some amount. When people see stories about rising ACA marketplace premiums, they may read or hear only the headline, or identify the problem and think it applies to their premium or employer premiums too. The chart above also shows that while a lot of people have followed the story, only 29% say that they had heard “a lot” about it.
Critics of the ACA have had some success blaming it for general problems in the health-care system. People may read news stories on premium increases as validating criticisms they have heard about the ACA. People may also not know when an outlier is an outlier. They may read about proposed 20%, 30%, or  40% increases in premiums for a marketplace plan in their state and not know whether the average increase across all plans is lower, whether it will affect their plan, or that they can shop for a much cheaper plan. A Kaiser Family Foundation analysis of commonly selected benchmark “Silver Plans” in 14 major cities found that the proposed average increase was 10%. That double-digit annual increase is about twice the size of increases in the group market, but it is far less than the 60% in Texas that Donald Trump recently mentioned. And, notably, most people in the marketplaces do not pay the premium increases; 85% receive government-funded premium subsidies. The government–meaning the taxpayer–pays.
 It would help counter public misperceptions if news reports explained that the proposed increases apply to only some of the 11 million people in the ACA marketplaces–and not everyone in the marketplaces or the 14 times as many people insured through their employer, people whose premiums are rising at historically moderate levels. The more than 100 million people covered by Medicare and Medicaid are also unaffected in all this.
The news media’s core job is to find and cover the news. Still, whether the issue is health care, Islam, or climate change, news reports fill knowledge gaps and correct misperceptions. There isn’t anyone or anything else in our system fulfilling such a role right now.
[post_title] => Public Misperceptions About Obamacare Premium Increases [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman looks at the debate about increases in Obamacare premiums and public misperceptions about who is and is not affected by them. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => public-misperceptions-about-obamacare-premium-increases [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:25:22 [post_modified_gmt] => 2017-02-06 19:25:22 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=193581 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 192918 [post_author] => 36621681 [post_date] => 2016-07-08 17:20:58 [post_date_gmt] => 2016-07-08 21:20:58 [post_content] =>
This was published as a Wall Street Journal Think Tank column on July 8, 2016. 
Americans across the country were rattled and outraged at recent incidents of police violence against minorities, this time in Baton Rouge and Minnesota–followed by a stunning sniper attack on police officers as they did their jobs alongside peaceful protesters in Dallas. These events pull us in conflicting directions: Support the police who so often, and selflessly, serve us so well, and support the minority communities whose residents are victims of discrimination by those sworn to protect them. The conflict is conspicuous in the statements of our leaders: condemning evident racism and discrimination by police; strongly supporting the police who put their lives on the line to do their jobs right, as the vast majority do every day; supporting peaceful protests and the Black Lives Matter movement; and harshly condemning the ambush of police in Dallas. During a presidential campaign voters naturally focus a great deal on the words and actions of national candidates and leaders. This is also a time, however, when mayors, police chiefs, and other local leaders can make a big difference.
Results from a Kaiser Family Foundation-CNN poll studying race in the U.S.
The pervasive sense of discrimination and mistreatment minorities feel at the hands of police and other institutions of authority cannot be overlooked. This is especially true of younger minorities and is at the core of many interrelated issues. As indicated by the chart above, which is drawn from a Kaiser Family Foundation-CNN poll on race in the U.S., two-thirds of young blacks say that they have been treated unfairly in the last 30 days because of their race.
Responses from Chicago residents to a Kaiser Family Foundation-New York Times survey conducted April 21-May 3, 2016.
A survey of Chicago residents by Kaiser and the New York Times found broad agreement among the public on a variety of steps that can be taken to reduce police-involved shootings, including expanding the use of dashboard cameras and body cameras, expanded use of tasers, better training, and diversifying police forces by hiring more minority officers. Virtually all of these measures can be implemented at the local level. Other steps not included in the chart but that can also help include expanding community policing. If local officials move quickly to address these recent crises, they could find opportunities to put in place measures that may have been blocked in some communities by local politics or lack of funding. What our elected national leaders say in the immediate aftermath of such traumatic events matters. A Justice Department investigation can be important as a way to redress civil right violations, to enforce laws on the books, and to act as a deterrent.  The FBI can aid in investigations. Governors and state attorneys general can step in when needed. But many of the problems between police and minority communities are uniquely local, and leadership from mayors and police chiefs can make a huge difference if they seek to work effectively with communities and move expeditiously to implement changes.
[post_title] => In Wake of Dallas, Minnesota and Baton Rouge Shootings, an Opening for Local Leaders [post_excerpt] => In this The Wall Street Journal Think Tank column, Drew Altman discusses how incidents in Dallas, Baton Rouge and Minnesota create opportunities for local leaders to take steps to reduce police-involved violence, citing data from the KFF-CNN survey of Americans on Race and KFF-New York Times Survey of Chicago Residents. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => in-wake-of-dallas-minnesota-and-baton-rouge-shootings-an-opening-for-local-leaders [to_ping] => [pinged] => [post_modified] => 2017-02-06 14:36:58 [post_modified_gmt] => 2017-02-06 19:36:58 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=192918 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) ) [post_count] => 6 [current_post] => -1 [in_the_loop] => [post] => WP_Post Object ( [ID] => 197362 [post_author] => 36621681 [post_date] => 2016-09-13 16:30:27 [post_date_gmt] => 2016-09-13 20:30:27 [post_content] =>
This was published as a Wall Street Journal Think Tank column on September 13, 2016.
Much has been said, and speculated, about Hillary Clinton’s health recently, including well before it was known that her doctor had diagnosed pneumonia last week. The New York Times and the Washington Post, among others, have called for presidential candidates to be more transparent about their medical records. It’s worth noting, as more information comes out and as more is sought, that full disclosure of medical records would almost certainly cause more harm than good. Serving up certain details of any candidate’s health, and past life, in a voracious social-media environment in which some elements of the media focus on “gotcha!” journalism and opponents leap to make attack ads has the potential to focus disproportionate attention on a candidate’s health–rather than a person’s readiness to govern and her or his positions on major issues. It makes sense that voters need to know whether candidates have a documented medical problem that could compromise their ability to serve as president or prevent them from completing their full term in office. That said, it seems possible to devise a formal system that both major parties could buy into, ensuring that such information is produced, rather than imploring individual candidates to produce it themselves.
 It’s easy to see the argument for disclosure if a presidential candidate has, say, serious heart disease or cancer, conditions that could affect one’s ability to serve. Now imagine the frenzy on social media if a candidate’s medical records indicated an episode of depression years before, or a sexually transmitted disease, or whether a male candidate uses Viagra, or if a candidate of either gender had been abused. These are points that understandably involve privacy. Full disclosure would tilt the spotlight to these issues, probably setting off long discussions on cable news about whether such issues should even be discussed. Not that long ago, well before the advent of social media and 24/7 cable news coverage, Thomas Eagleton was forced off the Democratic ticket after revealing that some of his past treatment for depression had involved electric shock. Imagine the constant focus on such information today.
The New York Times editorial seemed to suggest that Mr. Trump and Mrs. Clinton’s ages signify a special need to know all of their medical records: “Now Americans are deciding between Mr. Trump, who is 70, and Mrs. Clinton, who is 68. Whoever prevails will have to deal with round-the-clock demands, so it seems entirely relevant to inquire about their medical histories and current health.” Well, a healthy 48-year-old president could drop dead of a heart attack while jogging. It seems not far-fetched to suggest that unless a candidate has a known debilitating or potentially life-threatening medical condition, the American people would base their vote on other grounds–and take their chances on a candidate’s health in office, mindful always of who the vice presidential nominee is and that person’s ability to serve if needed. John F. Kennedy was the youngest person ever elected to the U.S. presidency, and he had serious health conditions. How might his close race against Richard Nixon have been affected by social media focus on his physical health? The Washington Post editorial said that “The goal must be to assure voters that they have disclosed anything that could hinder them while in office or create a risk that they could not serve a full term.” To meet this objective in future presidential elections, candidates from each party could agree to answer two medical questions: Do you have a medical condition that would compromise your ability to serve in office; and, if so, what is it? And, do you have a medical condition that might result in your being unable to complete your term in office; and, if so, what is that condition?
The answers to these questions along with their medical records could be submitted to a panel of three former surgeons general of the U.S. (or a similar group). Candidates could, of course, disclose more information if they wished to. This could be done soon after candidates are nominated so that a late-breaking health revelation does not unduly influence election results. Having an authoritative, objective panel certify the answers would be a way to identify problems if any exist without potentially making public decades’ worth of private information. The physicians on such a panel would have the ability to exercise medical judgment if needed and would be pledged to confidentiality. Even a panel of surgeons general may not quell the conspiracy theorists who will always be out there, but such a system could satisfy serious media and voters would have the information they need on candidates’ health without information that could both violate candidates’ privacy and distract from the larger issues at stake in U.S. presidential elections.
[post_title] => Risks in ‘Full’ Disclosure of Presidential Candidates’ Health Records [post_excerpt] => In this Wall Street Journal Think Tank column, Drew Altman discusses the risks of full disclosure of presidential candidates’ health records, and considers a possible solution to the problem. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => risks-in-full-disclosure-of-presidential-candidates-health-records [to_ping] => [pinged] => [post_modified] => 2017-02-06 13:53:48 [post_modified_gmt] => 2017-02-06 18:53:48 [post_content_filtered] => [post_parent] => 0 [guid] => http://kff.org/?post_type=perspective&p=197362 [menu_order] => 0 [post_type] => perspective [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 159 [max_num_pages] => 27 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_404] => [is_embed] => [is_paged] => 1 [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => a517a80131edab5de363f41243856467 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )

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