Understanding Donald Trump and Hillary Clinton's Health Care Reform Proposals



good morning Hank it's Tuesday let's talk about the health care proposals of Donald Trump and Hillary Clinton but first I should say that if you're interested in health care or health in general you should check out healthcare triage hosted by dr. Aaron Carroll it's an amazing show okay to understand the candidates proposals we need to look at the current health care system and its problems so journey back with me to 2008 at the time most Americans got insurance through private companies there was a publicly funded program for the elderly to get insurance called Medicare many low-income families got coverage through a publicly funded program called Medicaid and about 15% of Americans had no health insurance at all so broadly speaking back in 2008 our health care system had three huge problems the first was those 15% of people without insurance many people who didn't work for big companies including me literally could not get health insurance for any price because private insurers could deny you based on pre-existing conditions and for many other people private insurance plans were just too expensive to afford and that brings me to our second big problem back in 2008 which was that our health care just cost too much we were spending 16 percent of our nation's total economic output on health care most other rich nations spend under 10 percent like our health care costs were so stupefyingly high that in the United States more tax dollars per capita went to health care spending than Germany Japan the United Kingdom or Canada all those countries spending fewer tax dollars per person on health care had universal publicly funded health care the United States had nothing close to that also lastly for all this money we were spending not to insure everyone we weren't getting particularly good health care outcomes liked by almost any measure from life expectancy to medical errors to hospital admissions for preventable diseases the United States was not near at the top so then comes the affordable care act of 2009 which was designed to address some of these problems with the emphasis on the some the ACA was primarily designed to get more people health insurance about half of the newly insured were supposed to get Medicaid which was expanded to include everyone making up to 138 percent of the poverty line and the other half were supposed to get insurance through exchanges these marketplaces where everyone can get health insurance regardless of pre-existing conditions and the insurance would be affordable because households making up to 400% of the poverty line would have their insurance cost subsidized by the government on these exchanges see ACA also sought to reduce spending by lowering costs in Medicare and it raised some new taxes including one on medical devices so that the rest of the US healthcare system largely unchanged so that was the basic idea now the ACA has never been fully implemented because a 2012 Supreme Court decision made the Medicaid expansion optional for states and nineteen states have so far declined to do it which means the millions of poor Americans remain uninsured that said the ACA has been successful at reducing the number of uninsured people today it's around nine point one percent and it may have played a role although experts disagree about this in the slowing growth of health care costs in the United States for the 20 years before 2008 health care costs in the United States rose by an average of 8 percent in the last five years they've risen by an average of five point five percent but to be clear costs are still rising faster than inflation and median weekly earnings health care outcomes continue to lag behind and our health care system is still far far more expensive than any other nation on earth although the gap with Europe has closed a bit the ACA wasn't really designed to address those problems and it hasn't and there are other problems too and the employer market premiums and deductibles are rising as employers cover on average a smaller percentage of health care expenses than they did 10 years ago on the exchanges some insurance companies are offering fewer plans and because insurers are now required to offer comprehensive coverage with no lifetime benefit limits many people who previously had bare-bones insurance plans have seen their insurance costs go way up these are all real problems but it's very important to understand that the structural shortcomings of the United States healthcare system are much much older than Obamacare the ACA is not the reason our health care costs are so high and we know that because they were very high before the ACA so with all that in mind let's look at both candidates health care reform proposals using analysis from the RAND Corporation which is nonpartisan and widely considered centrist let's start with Trump's plan first he would repeal the ACA now Trump is said he'll find ways to make sure that private insurers continue offering plans to people with pre-existing conditions but he hasn't said how this would be possible Trump had also changed the way Medicaid is funded to block grants this would basically mean that states get to administer their own Medicaid programs but most analyses see these block grants over time involving lots of cuts and lastly Trump would allow insurance companies to sell plans across state lines and he would also make all hell insurance premiums tax deductible but remember these are deductions not tax credits so they would mostly benefit people with high incomes for reasons explained in this video all together the rand analysis concludes and I'm just going to quote here the Trump proposals decreased the number of insured increase out-of-pocket spending for consumers enrolled in individual market plans and raise the federal deficit compared to the ACA so here's how around nineteen point seven million people would lose their insurance if the ACA were repealed and Medicaid Block Grants would probably increase the number of uninsured further sales of plans across state lines and tax deductible premiums would get some people insured but all in all Rand concludes that about twenty point three million fewer Americans would have health insurance under Trump's plan out-of-pocket expenses would go up according to Rand for two reasons first because the tax deductions offered by the Trump plan are less generous than the tax credits offered by the ACA and secondly they estimate that sales of plans across state lines would raise out-of-pocket expenses because there would be an increase in the so-called bare-bones plans these are plans with high co-pays or deductibles or limits to annual or lifetime benefits Rand estimates that the average annual out-of-pocket expenses per person including deductibles and co-pays and insurance premiums and everything would go from about $3,200 per person to fifty seven hundred dollars per person and the deficit would go up because with the repeal of the ACA the taxes it raised would also be repealed as with the changes in Medicare reimbursement this would go or some taxes but most of the savings were in changes to Medicare so all in all under Trump's plan according to RAM the deficit would go up by about 5.8 billion dollars and I should add that all the nonpartisan analyses I could find agreed on all three fronts the Trump's plan would reduce the number of insured people increase out-of-pocket costs and increase the deficit okay let's move on to Hillary Clinton's proposals Clinton would amend the ACA and three big ways first she would introduce a $2,500 tax credit or $5,000 for married couples filing jointly that could be applied to health care expenses over five percent of income so if you're a single person making fifty thousand dollars a year and you pay five thousand dollars a year in health insurance premiums you would get a $2,500 tax credit because this is a tax credit and not a deduction it would be available to everyone not just high income households but that also means it would be more expensive secondly Clinton would reduce the marketplace premium Maxim I know this is a little confusing healthcare policy makes tax policy look like a pleasant walk in the park but basically right now the cost of health insurance premiums on the marketplace exchanges is effectively capped at nine point six percent of income to not benefit from the cap a family of four has to make ninety six thousand dollars a year or more basically Clinton's plan would lower the cap from nine point six percent to eight point five percent for most households but of course that program would also cost money and then lastly and maybe most interestingly Clinton would offer a public insurance option on the exchanges this would allow anyone not just seniors and low-income people to get their insurance from the government Rand hasn't yet updated its analysis of the public option but basically it would probably be cheaper than private insurance because it would share administrative costs with Medicare and so it would slightly reduce the deficit by reducing health care subsidies so all in all according to Rand I'm just going to quote again all of the policies considered increase the number of insured people and reduce consumers out-of-pocket spending on health care Rand estimates that the Clinton tax credit alone would lead to nine point six million more people getting health insurance and that households of all income levels would see their out-of-pocket health care expenses go down the biggest reduction in health care costs would be for families making between thirty and sixty thousand dollars a year but they would go down for every one but of course these programs would also increase the federal deficit by what Rand estimates to be ninety billion dollars so that is Rand summary Trump's plan would lead to significantly higher out-of-pocket costs fewer insured people and a modestly higher budget deficit Clinton's plan would insure more people lower out-of-pocket costs but raise the deficit more but of course you have to consider those deficits in the broader context of the candidates budget and tax proposals and to be clear overall under Trump's proposals the budget deficit would be trillions of dollars more than under Clinton's proposals the other question of course is will either of these proposals significantly reduce the overall cost of US health care and the answer is probably not the Trump campaign will argue that selling policies across state lines will increase competition but that is deeply contested and also even in the rosiest projections it wouldn't decrease spending much the Clinton campaign meanwhile will say that a public option would put real price pressure on private insurers and it might but I'll put a link in the dooblydoo explaining why a single-payer health care system would not magically fix the u.s. is problems the truth is this is a complicated multifaceted problem and anyone trying to sell you some both solutions probably isn't telling you the whole story and that includes me by the way this is definitely only an introduction if you want to learn much more about health care policy and health insurance and different strategies for dealing with it check out healthcare triage they've got a great video out now about medicaid's return on investment and next week they'll have a much more comprehensive analysis of the candidates health care plans so subscribe to them you can find sources as well as information about how to vote in the doobly-doo below Hank I will see you on Friday unless you have a child in the interim and screen Hank always says I need an end screen so I put some videos here about health insurance why you need it what the health care system in the United States is like why it's so incredibly complicated also if you're looking for a hot slice of tax policy that video is just one click away and rosianna drew you a bunny to cheer you up thanks Rosie Anna

26 Comments

  1. Trump 2020 !

  2. Lemme just say im proud to be Canadian ❤

  3. So he confirmed what we all knew. Neither Candidate knows how to help the country.

  4. It's not just "how much we spend", but WHAT we spend it on. Is it "healthcare", or is it preventative. We have NO preventative healthcare system. It's like we're putting out a fire aiming at the flames. But then again… it's DESIGNED that way.

  5. Socialism always ends in Starvation and genocide.

  6. There is a reason people come to America when they get cancer.

  7. We can’t give all control to government, but I don’t think the people can handle it on their own either, let alone pay for it. I don’t think any bill will find a sweet spot soon.
    I just hate leftist bias. So thank you for trying to keep it neutral as possible.

  8. Join the #CME & #CPD Accredited 14th Edition of International Conference on #HealthCare & #PrimaryCare during May 28-29, 2018 in #London, UK. Visit: https://healthcare.euroscicon.com/registration

  9. What is your proposed solution? You seem knowledgeable but there are so many issues I think it's hard to know what to do next.

  10. RAND is centrict? Is that why 92% of their donations were to Democrats. Looking for a friend

  11. Sep 2 – Benjamin Fulford – Rothschilds surrender US Corporation bankrupt!! USA Republic accepts shared human destiny.| 2017!! U.S.A. of America, Inc. (a foreign company) gone!! Debt completely negated!! We are once again A REPUBLIC!!
    https://youtu.be/EhUovfCXcxA

  12. LOL

  13. I've seen a few comments bragging about free healthcare in some countries. Just a reminder that it's not free, just free at the point of service. So it's pre-paid, kinda like insurance. I live in the uk, earn about £26k/year and pay around £2.5k/year National Insurance, which is a mandatory tax here if you work. This pays for my healthcare on the NHS, and also for the healthcare of everyone who doesn't pay National Insurance (children, the elderly, the unemployed, those who work cash-in-hand, and foreign visitors). I then pay tax on top of that for everything else.

  14. I had to backtrack a couple of times because the art in the background keeps catching my attention. I wanna see each piece up close!

  15. So in summary we had a healthcare system that was already offering expensive services, and to solve the problem our government started subsidizing it. The new rules made insurance premiums more expensive, combined with new taxes which means we are spending more of a percentage of our GDP on healthcare than ever even though we were already well above other nations.

    We fixed the problem of sending too much on healthcare by spending more. Funny that.

    You then compare both of the candidates general solutions to this illogical system created. Hillary's covers more people but whether or not we can afford it is a question not answered (it sounds great on the surface but bankruptcy comes later). Trump's plan is, well he has never made a very clear plan, so I don't know.

  16. But what most people don't get is the problem wasn't too much free market, we need more free market so prices can drop.

  17. So with Hillary Clinton do illegal immigrants get free medical treatment? who pays for that.

  18. I missed about half a minute thinking…"WHY HIS SKIN SO SMOOTH THO?!" *rewinds so I can pay attention this time*

  19. I have a question: A one system insurance nation wide would work but you have too much corruption with insurances making money, high medical cost which need a financial cap, politicians who get money from these companies and pay into campaigns. Passing laws where no US citizen can buy from another country or even travel out of the country to seek health care.

    Question is you would have to put a financial cap on all medical cost, STOP the doctors from over billing and over lab work that does not need to be done, STOP people who run into EMERGENCY when they could have went to a walk in clinic.

    MY QUESTION is???

    considering all that I stated above and fixing all of the above problems then how could you get one to work??

  20. John Green for President!

  21. I spoke with some exchange students from switzerland, they did inform me that there education and healthcare systems are universal. In America you have to pay to play. It would be the greatest debate of all time to universalize healthcare or education for that matter. This is a rags to riches nation. Hard work gets you where you want to go and of course a support group. A policy change to make healthcare universal for everyone, wouldn't patients love that, I would. We would have to make education universal to train a army of doctors to support that notion. Otherwise, who would really suffer. The doctors. I love the idea but could it actually work in America. Hmm.. I wonder when the mentioned countries established this universal system? How many years would it take to adjust for the demand. Intriguing!!

  22. Rather than focussing on Obama, Clinton  and trump care the US should look at other countries systems as yours is not working, here in Australia everyone pays 1.5% of annual income this is called Medicare,  The government system, you need to have private insurance as well so you don't have to go on a waiting list for operations, if you have private you get into hospital straight away, both systems offset each other on co payments, you cannot get out of paying Medicare, in the end someone has to pay and that's is everyone has to contribute, not each state going it alone, but that's what the brains trust gets paid to do, not commentators like me to worry about.

  23. Watching this in the aftermath of House Republicans voting to repeal the ACA, just listening to you describe the Clinton plan made my skin feel cleaner and my blood pressure went down. Also I should really go subscribe to Healthcare Triage now.

  24. I am getting election ads for my Province's provincial election, I wanna put the comment out stating I am too young to vote in the hopes that youtubes invasive ad algorithms will find this and give me less political ads.

  25. 8, The money I was stashing for college tuitions, now go to pay our health care coverages because of how horrific aACA turned out to be. it is literally imploding in on itself and the Democrats knew this was coming. They were warned over and over by a multitude of agencies it was going tits up and Democrats did nothing to fix the problems. AS USUAL!
    Being as you are over the TOP Democrat, you obviously put such a Democratic slant on this to sugar coat it,  to get the ignorants to vote for Hillary! Bad move. It discredits you since you didn't investigate this as much as you should have!

  26. 7, Now when you say the ACA was suppose to cover everyone including those with pre-existing conditions but the healh care providers do not have to accept that person with preexisting conditions if their insurances are so minimul that it will not benefit them to treat those patients with those pre-existing conditions. They are turned away as what we have been time & time again…even with premium health care plans.  The ACA is so ambiguous it gives the HC providers all the powers to decide who they treat and who they can just turn away regardless of your plans..

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