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During Thursday night’s debate, President Joe Biden and former President Donald Trump spent a considerable amount of time trying to claim credit for lowering the high cost of insulin

But the back and forth over insulin prices failed to address the underlying issue that many Americans fret over: the exorbitant cost of health care.

“The United States has a health care affordability crisis and this stark fact was utterly absent from the presidential debate,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University.

A February poll by KFF, a nonprofit group that researchers health policy issues, found that unexpected medical bills and the cost of health care are at the top of the list of peoples’ financial worries, with about three-quarters of the public saying they’re at least somewhat worried about being able to afford unexpected medical bills or the cost of health care for themselves and their families. 

“It was a huge swing and a miss,” Drew Altman, the president and CEO of KFF, said of the debate. “There was no meaningful attention to health care and, more importantly, to health care costs, which is absolutely an issue of major concern for voters.”

People in the U.S. pay roughly twice as much for health care than any other nation on earth, Gostin said, and yet the country’s health outcomes are inferior to most peer nations.

What’s more, health care costs continue to rise in America. 

National health care spending — which includes spending on physicians, services from hospitals, and prescription drug costs — is projected to grow to almost $4.8 trillion in 2023, increasing faster than the projected growth of the overall economy, according to a report published this month from the Centers for Medicare and Medicaid Services

Arthur Caplan, the head of medical ethics at NYU Langone Medical Center in New York City, said Biden and Trump’s attention on insulin was likely an appeal to the large core of voters with diabetes who have been advocating for lower insulin costs for years. More than 8 million Americans rely on insulin to survive, according to the American Diabetes Association.  

Still, Caplan said, insulin and drug costs in general are just one component of the overall health care system. 

“It was a hugely missed opportunity,” Caplan said. “Drug costs are a problem, but so are hospital charges and nursing home costs. Driving down drug prices helps, but it’s far from going to solve our cost issues.”

There will be another opportunity, Altman said, for Biden and Trump to address health care costs during the next presidential debate, which is scheduled for September.

Beyond the debate stage, Altman said he expects Biden to keep hammering away at health care costs because it’s an issue the president has an advantage over Trump.

Another KFF poll published in May found that more independent voters trusted Biden over Trump when it came to many areas of health care, including health care costs.

“Despite the fact that there was little or no focus on it, it will be a continuing focus for Biden and the Democrats,” Altman said. “I expect Trump to stay silent on this issue.”

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