‘Mr. Trump, are you out of your mind?’ Health policy questions I’d ask at the debate

Mr. Trump, are you out of your mind?

That would be my first question at the presidential debate, and it’s one I have been aching to ask the Republican nominee ever since I heard him say he’d “repeal [Obamacare], replace it, get something great!” While his vow is more of a rant than a plan, the limited specifics he has offered suggest it would strip 20 million Americans of their health-sustaining insurance. Hence my skepticism and that of the nonpartisan RAND Corporation and Commonwealth Fund.

Next up, Hillary Clinton and her proposal for reforming Obama’s health reforms with a Christmas tree of giveaways, from tax credits to a government-run public option. That might reclaim another 9 million from the ranks of the uninsured, Madame Secretary, but how would you pay a bill that the RAND-Commonwealth Fund report says will top $100 billion a year? And if you’re as serious as you say about insuring all Americans, why not sign onto Bernie Sanders’s Medicare-for-all plan that would stick private health insurers rather than the taxpayer with the higher costs?

I have moderated candidate debates before, and always dreamed about doing it on the presidential stage, where I could put the health and science issues I am passionate about front and center. If I were doing that tonight, here are some of the other questions I would ask even if I wouldn’t expect answers that were candid or clarifying:

Fighting pandemics. How would you equip the Centers for Disease Control and Prevention and the World Health Organization to take on and beat global pandemics like Zika?

That, as you should know, is more than a matter of offering up the funding Congress has refused to provide; it means jumping in early enough to keep the viruses off our shores. The only way to do that, says CDC Director Dr. Tom Frieden, is to forge precisely the kind of international coalitions that your America-first approach disdains, Mr. Trump. And before you pat yourself on the back, Mrs. Clinton, the Obama administration in which you were a critical link managed that kind of intervention with Ebola only after 10,000 people died in West Africa.

NIH funding. You both talk about waging trade wars and taking on the Chinese tiger, but what specific funding levels and other resources would you pledge to the National Institutes of Health to stanch America’s decline in basic scientific research? Where would you find those funds, and how would you re-forge what used to be bipartisan support in Congress?

Mental health coverage. We’ve been promised parity in mental health care and coverage for decades, but aren’t close to getting it. What will you do to make sure mental illnesses get the same attention, and reimbursement from insurers, that we take for granted for physical conditions?

One in five Americans suffers each year from depression, schizophrenia, or other debilitating and stigmatizing mental illness. You can help end the stigma tonight by telling us any mental illness you have suffered from in your lifetime.

Pharmaceutical company donations. You two share one thing when it comes to soaring drugs costs and price-gouging executives: You rail against both, but continue to take donations from the pharmaceutical industry (especially you, Mrs. Clinton).

Will you pledge tonight to give back those contributions? Will you put a concrete limit on annual price increases? What about executive salaries?

Global warming. Mr. Trump, you’ve called global warming “a hoax,” said you’re “not a big believer in manmade climate change,” and insisted we can wait to “see what happens.” Sorry to sound like a broken record, but are you out of your mind? Are you denying the clear-cut signs that global warming is happening? Who, other than men and women could be to blame? And for just how long do you suggest we do nothing about the floods, droughts, and other impacts here and everywhere?

Mrs. Clinton, this time you can crow. But as you know better than anyone, the early evidence on climate change came during your husband’s administration, when you two had your heads buried almost as deeply in the sand as Mr. Trump does now. So excuse my skepticism when I ask precisely how far you are willing to go in reorienting the American and global economies to move away from carbon-dispensing fossil fuels.

Health. There’s one more issue where you both have turned transparency on its head: your own health, or lack of it. You are the oldest candidates in the history of our republic, and we have a right to know how healthy (or unhealthy) you are. So here’s what I want to know: Will you commit to releasing not just summaries, but the full record of your last four health check-ups? If not, why not? And will you make available your primary care and specialty physicians to answer all of our follow-up questions?

You’ll likely resist such scrutiny of your medical records, seeing it as an unwarranted invasion of your privacy. But having just published a biography of Robert Francis Kennedy, I know how easy it is for presidential candidates to obfuscate when questions are raised about their health. Bobby showed us in 1960, when he was stage-managing his brother Jack’s successful bid for the Democratic nomination.

Senator Lyndon Johnson, JFK’s most serious competitor, had learned through sources that Jack had Addison’s disease, a serious condition in which the adrenal glands don’t produce enough hormones. “Doctors,” a senior LBJ aide announced at a press conference a day before LBJ confirmed he was running, “have told me he would not be alive if it were not for cortisone.”

If LBJ thought the Kennedys naïve and unready, Bobby’s same-day response to the medical charges made him think again. His brother, he insisted, “does not now nor has he ever had an ailment described classically as Addison’s disease.” Bobby proceeded to release a statement from JFK’s doctors proclaiming his health “excellent” and a page from his political biography attesting to the family’s openness in acknowledging his “adrenal insufficiency.”

The hair-splitting denials typified the Kennedy way of doing what it took to win, and are reminiscent of Trump and Clinton’s half-answers on their health. Jack did in fact have Addison’s. His adrenal glands were not just producing insufficient hormones, they were withering away. He had been getting cortisone injections for a decade, with Papa Joe going so far as to stash emergency supplies of the drug in safety deposit boxes wherever his son traveled. No one learned any of that at the time, however. The counterattack worked. LBJ was compelled to disavow his aide’s allegations and eat crow.

It was a decidedly different Bobby Kennedy who launched his own crusade for the White House eight years later. He took on then-President Lyndon Johnson in the Democratic primaries and set a standard for truth-telling that could be a model for today’s candidates at Monday’s debate and the rest of the campaign. The Bobby of ’68 still was a politician, not a prelate, but he was far from the prototypical panderer. He made sure that every speech on crime included a call for justice, and that what he said to chambers of commerce differed in the sequence but not the elements from what he said in the slums.

Simple evenhandedness was not nearly enough, however. He had come too far to revert to his hair-splitting or arm-twisting incarnations, and he’d never learned to mask his emotions. That meant making his audiences squirm. He told college kids everywhere he went that they could change the world, so why the hell weren’t they? He warned 800 medical students at Indiana University that they’d have to foot the bill for caring for the poor. As boos rang out, a doctor in training asked whether the senator would end medical students’ cherished draft deferments. “The way things are going here today, probably yes,” he said, smiling but serious.

It happened again at a luncheon of Civitans, a men’s service club. As his audience chewed on Salisbury steaks, he took the requisite questions on gun control and daylight saving time. Then he turned to his biggest issue — “American children, starving in America” — and asked, “Do you know, there are more rats than people in New York City?” Hearing guffaws, this senator who was kept up nights by images of the hungry children he’d met in the Mississippi Delta grew grim: “Don’t … laugh.”

Thomas Congdon Jr., an editor at the Saturday Evening Post who had started as a Kennedy cynic, attended the lunch and was struck by what he witnessed: “He was telling them precisely the opposite of what they wanted to hear.” It was demagoguery in reverse, and helped him win primaries in Indiana, Nebraska, and, on the day of his assassination, in the all-important state of California.

Are you listening, Hillary and Donald?

Larry Tye is a former health reporter at the Boston Globe and the author most recently of “Bobby Kennedy: The Making of a Liberal Icon.”

This story was originally published Sept. 26, 2016.