Tuesday's presidential debate covered primarily non-healthcare policy topics, but at least some airtime was given to the contentious issues of abortion and the COVID response, as well as a brief re-litigation of the now-14-year-old Affordable Care Act. Yet, despite former President Donald Trump and Vice President Kamala Harris' competing visions of the American Dream and our nation's future, some room for commonality may still exist on certain healthcare issues which pervade every American's life.
Republicans and Democrats disagree vehemently on multiple aspects of healthcare policy: the roles of private insurers, federal regulation of pharmaceutical innovation, the duty versus burden of government involvement in public health mandates, and many others. These are genuine questions -- answers to which lie beyond biomedical science and economics, in the realm of moral philosophy. They will not be solved on a debate stage. However, there are several policies on which bipartisan consensus can, and does, exist that the candidates did not touch on during the debate. And importantly, they all can meaningfully improve Americans' health and safety.
Take for instance enhanced bio-cybersecurity standards alongside federal investment in healthcare information technology (IT). Recent cyber-terrorism attacks show the devastating impact of even single-organization attacks in our interconnected healthcare system. For example, the exposed the records of over 600,000 patients and cost $160 million, while the (the nation's largest clearinghouse for medical claims) cost UnitedHealth Group (Change Healthcare's owner) $2.45 billion and crippled thousands of hospitals. The aging American healthcare IT system puts all of us at risk -- not just from data leaks, but from compromised medical devices and interruptions of care.
While multiple legislators have introduced bills on this subject -- from Sen. Mark Warner's (D-Va.) to senators Jacky Rosen (D-Nev.), Todd Young (R-Ind.), and Angus King's (I-Maine) bipartisan -- little action has been taken to advance the legislation. The susceptibility of our crippling healthcare IT will only accelerate as artificial intelligence (AI) systems and remote patient monitoring integrate increasing quantities and formats of health data.
Trump and Harris should also find alignment on electronic health record (EHR) interoperability standards. While many countries have challenges with effective sharing of patient records, the U.S. has notoriously ineffective practices (while fax machines have largely disappeared from most people's daily lives, they can almost always be found at hospitals). Not only does the fractured private EHR environment complicate providers' workdays, it may lead to unnecessary testing expenses. Consider the waste when an MRI or labs are repeated, despite being done recently at a different institution; in the worst cases, this can cause patient harm if prior genetic profiles are not accessible during acute admissions.
While CMS does incentivize provider adoption of EHRs (as opposed to paper records) and interoperability through the (MIPS), this is largely optional, and shameful when considering that new standards could save . Further, these standards apply only to providers -- not to the EHR companies themselves. While a is likely not feasible in the U.S. -- due to data security concerns and the theoretical benefits of EHR innovation from the private sector -- revamped federal standards for EHR communication would meaningfully improve patient care and reduce costs.
A final health policy area that ought to have consensus is site-neutrality of payments. Many may find it odd that the same service (e.g., a CT scan) is reimbursed differently () if conducted at a hospital as opposed to an independent clinic. It may seem even more absurd that the CT could be performed at the exact same center, and the reimbursement would be drastically different simply if the hospital purchased the independent clinic. Differences in so-called "facility" (hospital) and "non-facility" (non-hospital) rates for identical services not only baffle my mind, but contribute meaningfully to greater healthcare costs: in 2023, the Committee for a Responsible Federal Budget calculated in potential national health expenditure savings over a decade as a result of site-neutral policies in commercial insurance.
Further, as former HHS secretaries Alex Azar (R) and Kathleen Sebelius (D) called out in a , lack of site neutrality creates perverse incentives for hospital acquisition of physician practices. This has a slew of downstream effects: greater health system leverage in managed care contract rates with payers (indirectly raising commercial premiums) and physician burnout from more rigorous patient productivity requirements.
While there are benefits of hospital acquisition of practices (e.g., care continuity of patient journeys), many of these benefits can be achieved through other interventions; for instance, EHR interoperability would ameliorate many current challenges in effective guidance of patient journeys. Perhaps site neutrality is an achievable bipartisan goal in the next administration.
Thus, while political vitriol often interrupts societal progress, perhaps the potential future Trump or Harris administration will set aside its partisan disagreements for the safety and quality of our shared healthcare system. By addressing these fundamental challenges, our leaders may show us they can -- for at least a moment -- put country ahead of party.
is currently an MD candidate at the Icahn School of Medicine at Mount Sinai. He resides in New York City.