It's no surprise that politicians play fast and loose with the facts and terms that support their positions. But health care seems to get so jargon-y, so vague in the mouths of candidates it's laughable. So here are the results of my modest attempt to translate just a couple of the leading candidates' proposals into everyday language, with some possible consequences if implemented. In alphabetical order:
Health care is the leading Democrat's bailiwick, an issue she's been working on for a long time. She's staking a claim on defending Obamacare, going after high prescription drug prices, and women's reproductive health care.
- Tackle high cost of premiums, deductibles: If you have health insurance, you know your monthly premiums have only gone up, and your annual deductible (the amount you pay out of pocket for non-preventive services before your insurance kicks in) has climbed and climbed. Clinton wants to help people who buy insurance through health insurance exchanges (like HealthSource RI) by providing a “tax credit of up to $5000 per family to offset a portion of excessive out of pocket and premium costs above 5% of their income.” Here's the math I've been able to work out: if your family makes $75K a year, and you spend more than $3750 on deductibles and co-pays, you could qualify for some tax relief. For the millions who bought insurance on the exchanges, this could help. But it doesn't help people who buy insurance elsewhere (the majority), and I don't know how it brings health care costs in general down. Also, lots of families can barely find the $3750 to shell out-of-pocket in the first place.
- Support a "public option" in health care: So what the heck is the "public option" anyway? Is it the same as single payer health care? The Annenberg Public Policy Center's factcheck.org has a great post on this. I couldn't say it better myself: "Single-payer is a complete government-run health insurance system under which everyone is covered, e.g., Canada's system. The "public option" is a single federal insurance plan that would compete with private insurance companies." (Don't worry, we'll get to the concept of Medicare-for-all in a moment.) So, is a public option a good one? Well, for patients/consumers, if it's cheaper than the health insurance you currently have or can't afford now, maybe. If it requires doctors and other health care providers to accept lower payments from the federal government or lose out on business, maybe not. Some people say it'll quash private competition, others say those fears are overblown.
The Republican contender isn't new to health care; in 2015 he proposed an alternative to Obamacare in advance of the Supreme Court decision his party hoped would take Obamacare down. But so far, he doesn't have a health care proposal on his web site. Now, it's common knowledge he wants to repeal Obamacare, but there's not much detail beyond that. Here's what we do know.
- During the many Republican debates, Cruz has said he'd not only repeal Obamacare, but he'd allow insurance companies to sell policies across state lines. Those ideas are shared by other Republicans. His web site says he favors expanding Health Savings Accounts, and wants to "delink health insurance from employment." But I'm not sure how he proposes doing either of those things. If you "delink" your health insurance from your employment, assuming you have health insurance through your employer, that means you're either buying it on your own, or the government is buying it for you. I'm guessing Cruz favors the former.
The Democratic contender is proposing "Medicare for all." He wants universal health care, in other words, bringing the nearly 30 million Americans who still have no health insurance under the tent.
- "Medicare for all:" Sanders' main proposal is what amounts to single-payer health care, much like the system in Canada or many European countries. That means you pay nothing for your health care except a yearly tax. No deductibles, no co-pays, etc. It also means health care providers get paid with less variation (and potentially less than they'd like) by the federal government. His web site bullet-points the specifics of how he'd pay the hefty price tag - $1.38 trillion - including a tax on businesses, individuals, and eliminating some other tax breaks for health care companies. He estimates the plan will actually save money in health care costs, noting that the U.S. spends nearly $3 trillion a year on health care as it is. The question with this plan is this: will people support it? A recent Kaiser Health Tracking Poll found that only 24 percent of the public thinks we should establish such a universal option. But as it turns out, it matters what you call it. From the Kaiser poll:
"This month’s poll also explores the public’s reaction to a few terms used to describe the idea of expanding health insurance coverage to all Americans. Majorities say they have a positive reaction to the terms “Medicare-for-all” and “guaranteed universal health coverage” and fewer say the same for “single payer health insurance system” and “socialized medicine.” About half (53 percent) of Democrats say they have a very positive reaction to “Medicare-for-all” compared with 21 percent who say the same for “single payer health insurance system.”
Health care is one of Trump's top policy platforms. And yet, we've had few details about his proposals until recently. Now, as NPR's Alison Kodjak reports, he's filled in some blanks. According to his web site, Trump plans to:
- "Completely repeal Obamacare:" Trump wants to "eliminate the individual mandate" to have health insurance. If you don't want to buy it, you shouldn't have to, the theory goes. But for people who do want health insurance and have obtained it under Obamacare, what would repealing the law leave them? Maybe Medicaid, or an individual plan, bought directly from a health insurer. The problem is, not all states have expanded eligibility for Medicaid, and not all insurers offer individual plans. So if you don't have insurance through work or family, that's a dilemma. Also, bear in mind that Obamacare is a hugely complex law, going way beyond the individual mandate. It raised the age young adults can remain covered under their parents' plan, made funding available to experiment with new payment models for health care, and eliminated discrimination because of pre-existing conditions. And those are just a few of the law's provisions. What happens to the rest of those?
- "Require price transparency from all health care providers:" This is something Trump and many Hilary Clinton and Bernie Sanders supporters could probably agree on. And it's a huge push in Rhode Island. But does making prices transparent actually push consumers to make different choices about their health care or drive health care prices down? No one really knows. Interesting study from the Health Care Cost Institute recently found that only about seven percent of consumer health care dollars are "shoppable," meaning that patients only have a choice about where to spend their health care dollars on a small fraction of the total amount spent on their health care.
Questions about health care lingo bandied about during election season? Post a comment or email me.