As I write, Hilary and Trump have just taken New York & Super Tuesday causing what is possibly all of Williamsburg to stare off into the deep abyss and wonder how they could have possibly forgot that a vast majority of voters exist outside of the information vacuum of popular liberal internet sites they frequent.
You know. Reddit, HuffPo, Business Insider, NowThis, Vox… you get the picture.
(I dub thee, Pop-net)
Poking at my own millennial cohort aside, since ’08 it’s been clear that one of the strongest calling cards to earning the big ticket on a party’s ballot has been how a candidate decides to handle the immaculate clusterfuck known as American Healthcare. What once was a brilliant way to insure a bunch of teachers in Texas during 1929 has now blossomed into a complex, powerful spending powerhouse worth well over 3 trillion dollars. It is a huge facet of our national spending, and Americans have begun to chime in on what exactly about their healthcare spending really peeves them. 538.com wrote this insightful tidbit about how candidates have responded to the fact that our Medicare spending is projected to double by 2025.
So, yeah. The person behind the perennial wheels of America from 2016-2020 is pretty darn important.
This article is, first and foremost, a really really easy one to draft with minimal editing required and very little scientific research needed. Hence a good way for me to put off finishing my drafts on how mosquitoes could save the world and why working in an office environment is deadly.
I digress. I want this to be a primer for all of those voting in the primaries and beyond, to understand a critical aspect of a candidate’s campaign that has been largely overshadowed by their media antics. I may be late, but lazily researched knowledge that an SEO could have done in his or her sleep is better late than never.
The format will be as follows:
I. What is their big ticket healthcare contention
II. Which specific issues have they pressed upon
III. Does their track record resonate with this (using independent, non partisan onttheissues.org)
IV. My opinion
In the summary, I’ll address what is probably one of the most overlooked healthcare paradoxes that every single presidential candidate simply has been ill equipped to handle.
Donald Trump (aka Drumph)
I. Repeal Obamacare, allow citizens to purchase policies across state lines, & have a private-only insurance system.
II. The plan on his website (willfully crafted by only the best interns) states that his solution to the dissolution of Obamacare is the expansion of Health Savings Accounts (HSA). A fund that citizens can put their money towards that will avoid any taxation. This fund is accessible by any family member. Furthermore, the success of this hinges upon his additional plan of insurance that healthcare premiums are tax deductible.
III. OnTheIssues has Trump being for universal healthcare for the year 2000 on record, but since his decision to become a candidate he has not retracted that state, focusing instead on critiquing the Affordable Care Act.
My shoddy Opinion
IV. This plan actually isn’t as crazy as you think it is. It preserves a capitalistic insurance marketplace and is technically doable within the current confines of our system. However, its flaw truthfully lies in the false premise that Americans have the universal capacity to put a substantial amount of capital in his Health Savings Accounts. It’s essentially a glorified retirement account, and we already have stocks, bonds, and mutual funds to pool money as a family that is tax-deductible.
However, that being said, it is an novel idea (not Trump’s brainchild, mind you) and one that could possibly work if the public faithfully adopts a “wait and see” approach. Unlike other funds, having a clean line drawn around HSAs makes it easy to adjust policy. Making amendments to incentivize its usage is a lot more streamlined, making rules and regulations much more malleable. While I personally feel this is still redundant and people would be better off investing money elsewhere, I’m not 55 looking at a $5000 bill for a mandatory colonoscopy.
I. Push Affordable Care Act further, give citizens “Medicare for All”, & promote incentives for HIV/AIDS drug research.
II. His plan on his website (I’m still smelling intern all over this page) is grounded upon setting up an annual prize fund for HIV/AIDs research valuing at about 3 billion per year. However, his calling card is still the single payer system he wishes to instill alongside his 1.3 trillion dollar “Medicare for All”. Funding will be siphoned at a progressive income tax rate from top earners in the USA and mixed in with existed Medicare/Medicaid budgets to fund everything.
III. His voting history as a senator has been one of his strongest assets when it comes to his credentials as a consistent liberal politician and its no surprise to see this is mostly the case in OnTheIssues.org. He has consistently voted for expanded Medicare and child care however he has voted against subsidizing private insurers for covering prescriptions under Medicare and against small businesses buying private insurance packages.
My shoddy Opinion
IV. Man, oh man. Knowing my friends are ardent supporters and fans of this man, and are also the most likely to be perusing through this article right now, I’ll just stick with what I know are undeniable facts, because you can’t have an opinion around a Bernie fan without them assuming you’re devoid of any critical thinking skills. That’s my only shot at you guys, I swear, I love you.
Our current healthcare system is not single payer. That is, we give our money to insurance companies, who cover a portion of the hospital/physician while we may or may not be asked to foot the rest of the bill. When we’re older, the government steps in to do the rest of the spending legwork our incomes are simply too meager to cover. A single payer system in the context of Bernie’s campaign is no insurance middle man, only one entity (the US gov) paying costs, with maybe citizens footing the rest of the bill. European countries have done it, Canada has done it, and it has become the prerogative of the US left to ensure we’re next.
I will not comment on whether or not I believe this is good or bad, but will instead say that doing this with a republican majority congress is tough as nails, and creating enough jobs to replace those lost, with essentially eliminating private insurance, is incredibly difficult.
To give this topic some silver lining, this issue has indeed been on the table of many State Senates including Sander’s home state of Vermont. However, each time it has been shot down or hasn’t had the time to be re-introduced on the floor. The interest in certainly there, but there exists the opinion that nation-wide implementation would be too much, too soon. Between this or HSAs though, both are a risk with no real idea what could possibly happen. It’s six to five and pick em.
I. Repealing Obamacare (like, a lot), open market for health insurance purchasing, & health savings account expansion.
II. When it comes to healthcare, both Cruz and Trump seem to cover a lot of shared ground. However, unlike the latter, the former has introduced a Congressional bill titled the “Health Care Choice Act” introduced last year on March 3rd. Since then, his healthcare approach can be summarized in 3 points he unleashed on the Fox News Network for the world to see. It is three points, but in reality is a two pronged approach that only works if Obamacare in its entirety is repealed.
The first prong is opening up the health insurance market so that all companies can sell any package to any state without having to conform to specialized package for employers. Someone living in what he calls a “primary” state can buy insurance from a “secondary” state so long as the primary state has fulfilled its obligation in giving its citizens priority to chose their plan.
The second is another conservative favorite, the expansion of HSAs. Explaining this is pretty redundant given Cruz and Trump have effectively similar strategies.
III. Cruz is anything but inconsistent when it comes to the most central part of his plan. No Obamacare. What comes after has been the question that he really hasn’t had an answer for, or at least that’s what general media believes. This candidate wears his party’s platform on his sleeves and wherever the Republican majority goes, he will typically follow.
My shoddy Opinion
IV. Cruz doesn’t really bring anything new to the table over Trump, but rather just gives a clearer picture of what a GOP president’s healthcare efforts would look like given his history of actually being a politician. Which really isn’t saying much, because people still aren’t quite sure what the reform will look like or what it really fixes aside from repealing Obamacare.
I. Modification and expansion of Affordable Care Act, reducing costs of drugs, & the implementation of the Public Option.
II. This is the candidate that has the most eggs in the healthcare basket. She’s made it her M.O. since the 90’s as the FLOTUS and increasingly so during her ’08 run and stint as a New York senator. Her political platform when it comes to healthcare is chock full of specifics such as “[Creating] a tax credit for people whose out-of-pocket costs amount to more than 5 percent of their income” and so forth. It is little changes like these which makes up the base of her plan, essentially pushing for changes that were possibly cut from the original bill as it was being parsed by Congress.
Her primary soundbite is the reduction of out of pocket costs, the two most important components being drugs and co-pays. This is a testament to her skill as a politician given that polling has historically listed drug prices as one of the chief complaints by those who took the survey. It is a call and response that is typical of someone who has a staff that plays it by the book, not too different to what previous candidates would do during the previous two election cycles.
Perhaps what is most important here is the Public Option which was originally one of the major cornerstones the Affordable Care Act, but had to be axed to ensure its passing. Now, it serves as her response to Sanders’ “Medicare for All”. At its core, the Public Option is the formation of a government sponsored health insurance agency that the public has the “option” of buying into or not. Opponents have been quick to point out that having a public entity compete with private firms is contradictory of capitalistic values, given that the public agency would have an edge over those interested in entering the market from scratch.
III. Hilary is consistent in her inconsistency of her opinion throughout her career. Hilary-care aside, she once was a full throat-ed supporter of a nationwide single payer system only to turn heel once she had political investment into the Affordable Care Act. Where she once campaigned on coverage, she now talks about pricing. Like I’ve mentioned before, her opinion plays to the polls for better or worse.
My shoddy Opinion
IV. It’s tough to summarize Hilary’s overall stance on healthcare given that her involvement in this specific issue far out paces the other candidates on both sides of the isle. Even on her official campaign website, 6 of the 30 listed issues are healthcare related. At a 1:5 ratio, it edges out the others and gives her platform a little more gravitas on this issue.
Her stance, however, strikes a unique dichotomy with that of Sanders. Where Hilary wants essentially line-item changes, Sanders wishes for a complete overhaul. It has been argued that her approach is much more realistic and feasible, its success largely based upon her influence in Congress. I wouldn’t be so quick to call it a closed case though, as ultimately her ability to pass healthcare reform is still just a “what if” much like her opponent.
If isn’t evident yet, I have to disclose that I was a pretty ardent Hilary supporter back in ’08 and am trying to do my best to sound impartial. We all know of the coverage of her moral issues, hawking against big pharma/banks even though she takes their checks. As I was writing what was supposedly the third paragraph, I noticed I was going a bit defensive. So I’ll just cut it off here and hope you take my word for it when I say I really really am trying to be pretty neutral here, its just kind of hard.
Too Bad They Can’t Do Anything About Cost
You know what’s easy though? Pointing out what has been pretty obvious to a lot of people for a very long time. And that’s how none of what any of the above bring to the table address the heart of the issue at hand: Cost.
Cost of healthcare is the lowest common denominator, because ultimately even coverage comes down to whether or not someone (be it you, the government or your insurance) can afford your hospital bills.
Okay, let me break this down for you.
Lets say you get a disease that requires you to go to the hospital and take some drugs as the treatment. You go to the hospital, take a bevy of tests, get your drugs and receive your bill. Oh snap! That bill is huge, but you swore you did your homework and made sure your currently employer provided you with the best health insurance possible. Crumpling that bill, you pick up the phone and let the fresh faced college graduate who just started at Blue Cross bear the brunt of your righteous fury. After all, it’s the insurance’s fault for not giving you that sweet, sweet coverage right?
Pfft. Not entirely.
Don’t be alarmed though, more than half of Americans are equally confused about their bill and how much their treatment just cost. Heck so were two nerds, ahem, professors at the Harvard Business School. Thankfully though, they’re professors at the Harvard Business School, and proceeded to dissect this problem with the precision of Prince on his guitar during a face melting solo (RIP). Guess what they wrote in the New York Times? Oh never mind, here it is.
Basically, whenever you take a test of any sort that uses any complex machinery, there is a huge cost associated with it. Cutting edge treatment needs accurate information about your body to work with, and that requires the latest and greatest in medical tech. While the NY Times article goes into the nitty gritty of whether or not doctors over prescribe tests, the fundamentals remain prevalent. When you own a hospital and you need a 3 million dollar MRI machine to help cancer patients, you need to make that money back.
Thankfully you have this handy thing known as a Charge Description Master, essentially a giant list decided by an arbitrary committee that dictates how much certain treatment and tests costs. Whether or not these committees are ethical is a debate unto itself, but when medical technology releases new stuff for hospitals to use, or new treatments, or new drugs, it costs more.
The Hasting Center even went out of its way in pointing out how med-tech contributes 40-50% of annual cost increase in America. So combine this along with the mysterious Charge Description Master and you have something that very few people have complete knowledge of, or even talk about.
Just like your candidate.
Have a fun time at the polls!