For me, the saddest part of the 2016 presidential election is not that we have two of the most disliked presidential candidates in history but that so little attention is being paid to health care.

You may have noticed that health care rarely comes up in campaign speeches or in debates, and when it does it’s often scripted empty promises. Donald Trump has a plan entitled “Healthcare Reform to Make America Great Again.” Hillary Clinton talks about having fought for health care her entire career. It’s unclear if either of them — or indeed any candidate — can make a meaningful change.

Donald Trump talks about repealing the Affordable Care Act (aka Obamacare) and replacing it with “something terrific.” That “terrific” is vague or a secret plan — maybe similar to the secret plan to defeat ISIS. Hillary Clinton talks about “universal, quality, affordable health care” by building on the ACA, but is vague about how she would persuade a Republican-controlled Congress to support her.

To set the record straight, the two candidates were invited by the prestigious New England Journal of Medicine, for this week’s edition, to provide their visions of health care in America. Hillary Clinton presented a four-point plan, and Donald Trump did not respond.

Clinton would improve the ACA, make health care more affordable, integrate health care, and secure true innovation. The Clinton plan would provide $5,000 tax credits per family for out-of-pocket costs. Additionally, it would limit out-of-pocket prescription drug costs to $250 a month.

According to his website, Donald Trump’s plan is to repeal the ACA, allow people to purchase insurance across state lines, and provide states with block grants for Medicaid, among other provisions. Trump’s plan would leave 18 million Americans, presently covered under the ACA, without health insurance, eliminate preexisting conditions requirement for insurance and not allow young adults up to age 26 to be covered on their parent’s insurance policy.

Experts say allowing insurers to sell across state lines will have little impact, and that block grants for Medicaid, a long-held position by the Republican party, would cap some Medicaid costs.

Something both candidates agree on is allowing Medicare to negotiate with pharmaceutical companies in order to lower drug prices and prevent price gouging — as we have seen from the manufacturer of EpiPen.

Sadly, neither plan, Republican nor Democratic, meaningfully addresses the ticking time bomb for the nation: the rising cost of health care, due in part to overuse and unnecessary care.

Repealing the ACA would do nothing to bring costs down — in fact, according to factcheck.org, during 2002 to 2006 under George W. Bush, health care premiums rose at a higher rate (58 percent) compared to the increase under Obama (33 percent), with the ACA in effect.

Addressing health care costs must be the No. 1 health care priority for the next president. The two plans at present are much like moving deck chairs on the Titanic.

America spends nearly a fifth of its GDP on health care, in effect siphoning money from needs such as education such as infrastructure. High employee insurance costs also limit American companies’ ability to expand. The cost to taxpayers for treating a 95-year-old nursing home patient with dementia on the ventilator in the ICU for over a week exceeds the cost of a teacher’s one-year salary. Yet we can’t seem to see this as a priority for society or the government.

Reforming health care takes political capital — and at times angering the voter base. More so, too many vested interests have their hands in the $3 trillion ($9,523 per person) health care cookie jar. No matter who wins, the public will need to push for continued reform of our health care system. This is the only way real change will happen.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and the Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain. 

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