{"id":37472,"date":"2016-09-27T14:09:54","date_gmt":"2016-09-27T13:09:54","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37472"},"modified":"2016-09-27T14:11:42","modified_gmt":"2016-09-27T13:11:42","slug":"jeanne-lenzer-clinton-and-trump-on-healthcare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/27\/jeanne-lenzer-clinton-and-trump-on-healthcare\/","title":{"rendered":"Jeanne Lenzer: Clinton and Trump on healthcare"},"content":{"rendered":"

\"jeanne_lenzer\"<\/a>The Presidential Debate That Wasn\u2019t<\/strong><\/p>\n

The 90 minute presidential debate between Hillary Clinton and Donald Trump ended last night without a single word about healthcare. Yet two-thirds of voters said \u201cthe future of Medicare and access and affordability of healthcare are top priorities for the candidates to be talking about during the 2016 presidential campaign.\u201d\u00a0[1]<\/span><\/p>\n

Clinton, a Democrat, and Trump, a Republican, have both said they support \u201cuniversal\u201d healthcare and both rely on market forces and private insurers to provide coverage for healthcare. What follows is a summary of what is\u2014and isn\u2019t\u2014known about the candidates\u2019 positions on various healthcare issues, followed by comments from critics right and left.<\/p>\n

On health insurance and \u201cuniversal care\u201d<\/em><\/strong><\/p>\n

Clinton says she will \u201cdefend and expand\u201d the Affordable Care Act, which has reduced the number of individuals without health insurance from 47 million before the Act to approximately 30 million still uninsured as of the beginning of this year. She would allocate $500 million to help enroll those still unenrolled into a plan. [2,3]<\/span><\/p>\n

Trump says he will ask Congress to \u201cdeliver a full repeal of Obamacare.\u201d He doesn\u2019t give specifics about how he will achieve universal coverage but says he will support a plan that \u201cfollows free market principles.\u201d [4]<\/span>\u00a0This contradicts his earlier statements that he would cover everyone under a plan paid for by \u201cgovernment\u201d [5]<\/span>\u00a0and he no longer supports mandatory insurance coverage. [6]<\/span><\/p>\n

On Medicare<\/em><\/strong><\/p>\n

Both Clinton and Trump express their support for Medicare. \u00a0However, Trump\u2019s support appears qualified and at times contradictory.\u00a0 He makes no mention of Medicare in his 7-point plan.\u00a0[7]<\/span>\u00a0 At times he has said he would make cuts to Medicare and at others he says it must be preserved. [4]<\/span><\/p>\n

Clinton says she supports a plan to allow individuals age \u201c55 years or older to opt in while protecting the traditional Medicare program.\u201d\u00a0[3]<\/span><\/p>\n

On Medicaid<\/em><\/strong><\/p>\n

Clinton says \u201c19 states\u2026have left 3 million Americans without health insurance because their states have refused to expand Medicaid.\u201d\u00a0[2]<\/span>\u00a0She says she will \u201cincentivize\u201d states to expand Medicaid.<\/p>\n

Trump says he supports taking Medicaid out of the hands of the federal government and turning it over to individual states using block grants.\u00a0<\/em><\/p>\n

On care for immigrants<\/em><\/strong><\/p>\n

Clinton supports expanding healthcare to everyone \u201cregardless of immigration status.\u201d [3]<\/span><\/p>\n

Trump claims that \u201cProviding healthcare to illegal immigrants costs us some $11 billion annually,\u201d and says he will enforce laws so there are no illegal immigrants in the country.\u00a0<\/em><\/p>\n

On reining in healthcare costs<\/em><\/strong><\/p>\n

Clinton says she would work with interested governors to establish a \u201cpublic option\u201d that would be a government-run alternative to private insurance. [2,8]<\/span>\u00a0She says she would lower out-of-pocket expenses for individuals and families by placing unspecified caps on those expenses.<\/p>\n

Trump wants to allow the sale of health insurance across state lines, which he says will allow \u201cfull competition\u201d and force costs to go down.\u00a0 He also supports Health Savings Accounts, long-favored by Republicans. The accounts, which can only be used with high-deductible insurance plans, allow individuals or families to use a tax-free savings account to pay for out-of-pocket expenses. [6,8]<\/span><\/p>\n

Prescription drug costs<\/em><\/strong><\/p>\n

Both Clinton and Trump support allowing drug importation with quality controls to lower prescription drug costs. Both say they support allowing Medicare to negotiate drug prices, which is currently prohibited.\u00a0[8]<\/span>\u00a0<\/em><\/p>\n

On Abortion<\/em><\/strong><\/p>\n

Clinton wants to \u201censure that all women have access to preventive care, affordable contraception, and safe and legal abortion.\u201d [3]<\/span><\/p>\n

Trump says he opposes late-term abortion except when the life of the mother is threatened or in cases of rape or incest. He would defund Planned Parenthood as long as it provides abortions, and ban any government payments for abortion by making the Hyde Amendment permanent.\u00a0<\/em><\/p>\n

Who gets the money?<\/em><\/strong><\/p>\n

Clinton outstripped every candidate by very wide margins in receiving money from almost every sector, from banking to gambling and casinos, according to the Center for Responsive Politics. \u00a0During the 2016 cycle, Clinton has received more than $17.1 million from the healthcare sector.<\/p>\n

Trump came in behind 7 other candidates to receive $1.3 million in donations from the healthcare sector.<\/p>\n

What the critics say<\/em><\/strong><\/p>\n

Adam Gaffney, a critical care doctor and advisor to the board of Physicians for a National Health Program told The BMJ <\/em>that Clinton\u2019s \u201cpublic option\u201d is \u201ccoming from the right place but won’t solve the fundamental problems of the healthcare system.\u201d He said it won\u2019t fix the problems of the 29 million who are still uninsured, as \u201cthe public option would\u2014just like the private plans it competes with\u2014impose premiums and cost sharing that are unaffordable for many.\u201d\u00a0 Nor would it address the 31 million non-elderly adults who are underinsured, he said citing a Commonwealth Fund study, which found that among the underinsured, 47% were forced to empty their savings accounts; 34% to take on credit card debt, and 7% to declare bankruptcy. [9]<\/span><\/p>\n

Gaffney says neither candidate is supporting the one plan most favored by the public; a federally funded, universal health program, which is supported by 58% of Americans, according to a Gallup poll. [10]<\/span>\u00a0 He said a Canadian-style plan could dramatically cut administrative costs, shaving off more than $350 billion or 15% of healthcare expenditures. [11]<\/span><\/p>\n

Yevgeniy Feyman, adjunct fellow in health policy at the Manhattan Institute, a \u201cleading free-market think tank,\u201d told The BMJ <\/em>that \u201cDonald Trump doesn’t really know what Donald Trump wants on healthcare; he’s taking bits and pieces from this grab bag of vaguely sounding conservative ideas and some more liberal ideas.\u201d Feyman says he has \u201ca lot of reservations\u201d about Hillary Clinton, and that the cost of her proposals has not been accurately assessed.\u00a0 However, he said, \u201cShe has a much more concrete plan that you can negotiate with.\u201d Feyman takes issue with both Clinton and Trump regarding their support for drug importation, saying \u201cIt would have a lot of negative effects\u2026including an impact on R&D spending.\u201d<\/p>\n

Wendell Potter, former public relations executive for health insurers, told The BMJ <\/em>that Trump\u2019s plan to reduce costs by allowing insurers to cross state lines \u201csounds swell,\u201d but he said, \u201canyone who knows something about the insurance industry knows it won\u2019t create competition and lower costs.\u201d [12]<\/span><\/p>\n

Potter, who has been outspoken about \u201cinsurance industry greed\u201d said, \u201cNeither candidate is suggesting anything \u201cradical or transformational; both are working with a system that is largely controlled by the health insurance industry. Our political system has become so corrupted that we have to address the problem of money in Congress or [truly] ambitious proposals will never make it.\u201d<\/p>\n

Jeanne Lenzer<\/strong> is a medical investigative journalist who sadly has to leave fascinating tidbits about various stories on the cutting room floor. The Backstory is an attempt to archive some of those bits and to provide a bit of insight for the public about the \u201cbehind-the-scenes\u201d aspect of investigative journalism.<\/em><\/p>\n

Competing interests:<\/strong> None declared.<\/em><\/p>\n

References:<\/strong><\/p>\n

    \n
  1. Kaiser Health Tracking Poll 2016<\/a>: Kaiser Family Foundation.<\/li>\n
  2. Clinton H. Hillary Clinton\u2019s Commitment: Universal, Quality, Affordable Health Care for Everyone in America 2016.<\/a><\/li>\n
  3. Clinton H. Healthcare: Universal, quality, affordable health care for everyone in America. 2016.<\/a><\/li>\n
  4. Donald Trump on Healthcare: OntheIssues.org; 2016<\/a>.<\/li>\n
  5. 60 Minutes interviews Donald Trump on healthcare<\/a>.<\/li>\n
  6. Gurnon E. Where Trump And Clinton Stand On Health Care And Medicare<\/a>. Forbes\u00a0<\/em>2016.<\/li>\n
  7. Trump D. Healthcare Reform to Make America Great Again<\/a>. 2016.<\/li>\n
  8. Snapshot of Where Hillary Clinton and Donald Trump Stand on Seven Health Care Issues<\/a>.<\/li>\n
  9. 31 Million People Were Underinsured in 2014<\/a>; Many Skipped Needed Health Care and Depleted Savings to Pay Medical Bills: The Commonwealth Fund; 2015.<\/li>\n
  10. Majority in U.S. Support Idea of Fed-Funded Healthcare System: Gallup Poll<\/a>.<\/li>\n
  11. Jiwani A, Himmelstein D, Woolhandler S, Kahn JG. Billing and insurance-related administrative costs in United States’ health care: synthesis of micro-costing evidence. <\/a>BMC Health Serv Res. <\/em>2014;14:556.<\/li>\n
  12. What Trump Doesn\u2019t Get About Those \u201cArtificial Lines\u201d Around States. 2016<\/a>. Accessed 8\/10\/2016.<\/li>\n<\/ol>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    The Presidential Debate That Wasn\u2019t The 90 minute presidential debate between Hillary Clinton and Donald Trump ended last night without a single word about healthcare. Yet two-thirds of voters said […]<\/p>\n

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