Today’s Managing Health Care Costs Number is 1756
Not many can say that they got their wish out of the second presidential debate – Trump threatened to misuse the judicial system to prosecute his opponent, and the lewd 2005 videotape released on Friday hung over the entire affair. BUT – there was some real talk about health care!
Early on, Trump pointed to the failure of ObamaCare
….horrible things like Obamacare, where your health insurance and health care is going up by numbers that are astronomical, 68 percent, 59 percent, 71 percent…
Not exactly. Premium rises will average 9% - still far too high – and the increased premiums for those who are eligible for subsidies are lower.
An audience member asked the question:
Premiums have gone up. Deductibles have gone up. Copays have gone up. Prescriptions have gone up. And the coverage has gone down. What will you do to bring the cost down and make coverage better?
Clinton noted 20 million additional Americans have insurance, the elimination of lifetime limits and denial of coverage based on existing illness, coverage of those under 26 on their parents’ policy, and elimination of higher premiums for women.
Trump suggested repeal and replacement by “something less expensive,” although the ACA has cost far less than as initially predicted. (h/t to Sarah Kliff who did real time fact checking on health care). He focused on eliminating “state lines” in health insurance, ignoring substantial evidence that allowing sale of policies across state lines is unattractive to health insurers and would be unlikely to substantially lower costs – which are driven by provider costs in each community. Entrance of a new insurance company from out of state with no leverage to get lower rates would be no help –and could cause additional purchaser fragmentation and higher total costs. The states now regulate health plans to be sure they are financially sound – and the boosters of cross-state insurance sales have not articulated a plan to establish national regulation to replace this. Trump also alleged that Canadians were flooding across the border to get American medical care – which is patently untrue. He also accused Clinton of supporting single payer – which would be a real surprise to Bernie Sanders supporters from the Democratic primary.
Anderson Cooper asked Clinton about her husband’s statement that ObamaCare is “the craziest thing in the world.” She responded
Look, we are in a situation in our country where if we were to start all over again, we might come up with a different system. But we have an employer-based system. That’s where the vast majority of people get their health care.
And the Affordable Care Act was meant to try to fill the gap between people who were too poor and couldn’t put together any resources to afford health care, namely people on Medicaid. Obviously, Medicare, which is a single-payer system, which takes care of our elderly and does a great job doing it, by the way, and then all of the people who were employed, but people who were working but didn’t have the money to afford insurance and didn’t have anybody, an employer or anybody else, to help them.
That was the slot that the Obamacare approach was to take. And like I say, 20 million people now have health insurance. So if we just rip it up and throw it away, what Donald’s not telling you is we just turn it back to the insurance companies the way it used to be, and that means the insurance companies …get to do pretty much whatever they want, including saying, look, I’m sorry, you’ve got diabetes, you had cancer, your child has asthma… you may not be able to have insurance because you can’t afford it. So let’s fix what’s broken about it, but let’s not throw it away and give it all back to the insurance companies
Cooper pressed Trump about whether he would mandate health coverage – which is critical to convincing the healthy to be in the insurance pool. He again cited restrictions on selling health insurance across state lines, and added block granting Medicaid for good measure. (Brooke Gladstone of On the Media has a good summary this week of the impact of block granting Welfare to the states during the Clinton administration. States’ refusal to expand Medicaid under the ACA gives us a good sense of how this would work!)
Clinton got one more health care comment into a discussion of her 30 years of public service.
Eight million kids every year have health insurance, because when I was first lady I worked with Democrats and Republicans to create the Children’s Health Insurance Program. Hundreds of thousands of kids now have a chance to be adopted because I worked to change our adoption and foster care system. After 9/11, I went to work with Republican mayor, governor and president to rebuild New York and to get health care for our first responders who were suffering because they had run toward danger and gotten sickened by it. Hundreds of thousands of National Guard and Reserve members have health care because of work that I did, and children have safer medicines because I was able to pass a law that required the dosing to be more carefully done.
So – 1765 words on health care by my count (a bit more than 10% of the total words, as transcribed by Politifact) It’s clear from this that Clinton has a deep understanding of health care – and an appreciation that reforming an existing system that is 1/6 of the economy and is caring for almost all Americans is very difficult. Donald Trump repeated standard speaking points.
RANDevaluated the Trump health care plan, vague as it is, and determined that it would lead to loss of coverage for 20 million Americans with an increase in the federal deficit, while Clinton’s plan would increase those insured by 9 million with a larger but not huge increase in the federal deficit.
Presidents don’t create health care policy on their own, and any elected President will have to work with Congress as well as health care stakeholders, including patients, providers, insurers, pharmaceutical companies, employers and others to drive reform. Health care value will only increase as the delivery of health care itself is improved. The financial system undergirding health care can support or hinder this transformation –but it cannot alone improve the value of health care.
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