This election season could not get any dreadful. Now with both parties not discussing their take on health policy due to much publicized scandals on both sides, citizens of America are left in the dark.
Luckily, the medical journal The Lancet has released a series of discussions where it delves into possible policies that each nominee might adopt once they get elected, and the consequences it will have on the US population and possibly the rest of the world.
Healthcare remains the most controversial topic as both nominees have suggested polar opposite solutions, ones which heavily involve President Obama’s health reforms, either in the form of its improvement or complete annihilation.
Under these reforms, Obama’s health legacy includes the passing of the landmark Affordable Care Act (ACA), more commonly known as Obamacare, which has led to 20 million more Americans gaining health insurance, the curbing of coal emissions under the Clean Power Plan and strong support for biomedical research.
Obamacare has been the most significant act since 1965’s inception of Medicare and Medicaid. It was meant to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare.
It introduced mechanisms including regulations, subsidies and insurance exchanges. The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions.
Despite these improvements, massive problems are still relevant, including ever-rising healthcare costs, high un-insurance rates with an estimated 30 million Americans uninsured, a flat medical research budget and entrenched health inequalities.
Let’s analyze what’s at stake here:
Trump’s Healthcare Policy
Trump is looking to abolish Obamacare and build on from there. Republicans supported this strategy as last week the Obama Administration confirmed that premiums for mid-level policies sold on the federally run health insurance marketplace in 38 states would increase by an average of 25%.
There’s however no mention of Trump’s willingness to uphold the ban on discrimination against people with pre-existing health conditions or his support for allowing Medicare, which provides health insurance to 55·5 million US citizens who are older or who have disabilities, to negotiate lower prices with drug companies.
Trump’s strategy would also help reduce healthcare costs by allowing import of cheaper prescription drugs from other countries, allowing all working individuals to deduct insurance premiums from their tax returns, similar to as self-employed workers can do now, and letting consumers set aside money for health expenses in tax-free health savings accounts (HSAs). However, HSAs already exist, created under a 2003 federal law. Another Trump proposal and long standing Republican plan would let consumers buy insurance from other states.
According to a report released on Sept 23 by the Commonwealth Fund and the RAND Corporation that models the predicted effects of the candidates’ health-care reforms, these policies would increase the number of uninsured individuals by between 16 million to 25 million people in 2018 compared to Obamacare. Financially burdened individuals and those with severe illnesses will be affected the most. Citizens with private insurance would also have to make greater out-of-pocket payments under Trump’s suggested policy compared to Obamacare.
Hillary’s Healthcare Policy
Hillary Clinton wants equal healthcare insurance rates for both genders. Women are being charged more than men. She has full faith in the Affordability Act and wants to further improve it.
Her other strategies include a $250 limit on out-of-pocket drug spending, and importing drugs. Other reforms include tax credits of up to $5,000 per family for high out-of-pocket medical expenses, which will give more support to government in reducing premium hikes, and encouraging healthcare delivery innovations.
She would also expand coverage to uninsured or underinsured Americans by continuing incentives for more states to improve and spread Medicaid facilities, allowing people to receive Medicare insurance at an early age, starting at age 55 years instead of waiting until they are fully eligible at 65 years, and pursuing the creation of a public option, which will be a government-run insurance plan similar to Medicare that could be a cheaper alternative to commercial plans.
As premiums on private insurances increase, forcing financial burden on people and making them seek other options, the public option plan seems like a good idea for some Democrats.
According to Hillary’s stance on healthcare, the number of insured individuals would increase by between 400,000 and 9.6 million people in 2018 and decrease consumers’ health spending compared to current policies set by Obama’s administration. Refundable tax credits are predicted to have the most impact, increasing coverage by 9.6 million and decreasing average spending by up to 33% for individuals who are not financially well off.
Problems With The Current Policy
Despite spending millions on setting up Obamacare and investing in bioresearch, it has failed to solve the number one problem: affordable healthcare for all. Out of all the developed nations, US healthcare system is the worst because it lacks a single payer system. In countries such as France and Canada, government pays for all expenses with taxpayer’s money.
In US, however, there are third party, for profit insurance companies that provide expensive coverage and despite their high costs, many individuals still have to pay out of their pockets for expensive medical treatments despite the government subsidizing most of these costs. Essentially, and quite obviously, the conditions of life matter to our health.
And in the USA, these conditions are quite worrisome. In a 2013 report, an expert panel of the National Research Council and the Institute of Medicine found that Americans die younger and experience more health issues and injuries than individuals belonging to other high-income nations. This large and growing health disadvantage relative to other countries is seen from birth to age 75 years, among both sexes, regardless of financial status and across all races and ethnicities.
The causes of these poor health outcomes in the USA are many and complex. Unfortunately, refining the Affordable Care Act and spending more on biomedical research alone will not be enough, and will be an uphill task for the next president. A variety of factors are at play, including education, economic incentives, financial opportunities, housing schemes and quality of food.
Whoever you decide to vote for, one thing’s for sure: the next administration will have to make tough decisions while the whole world is watching.