Health

Clinton vs. Trump on Health Care

Diagnosing the differences between the two candidates

No viable presidential candidate would adopt a platform that doesn’t call for enhancing the quality or quantity of medical care in the United States. But how each one of the front-runners addresses coverage and cost is critical.

Most of our out-of-control health care spending is unseen by the average voter.

All too often, health care policy is determined in an ivory tower where cost issues aren’t meaningfully addressed. It’s crucial to do so, however, because our budgetary problems in government stem largely from an unfettered rise in health care costs, which have trickled down to the larger economy.

Many of my own peers need to be reminded that it’s not Department of Defense costs have that blown up our budget deficit — it is health care. Medicare and Medicaid spending are going up at a radical rate compared to inflation, government-stated or not.

How bad is this?

During fiscal year 2005, for example, we spent a total of $652 billion on Medicare and Medicaid combined. In fiscal year 2015, we spent a total of $1.297 trillion, or close to double — 10 years later.

This was not mostly centered on Medicare — meaning, spending on retirees. It was across-the-board spending for all age groups served. Medicaid went from $182 billion to $349 billion, which was a growth rate that far exceeded inflation.

It is interesting, however, that neither Donald Trump nor Hillary Clinton is playing entirely to their base on health care issues.

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Trump on Health Care
Donald Trump has made it clear that he strongly supports a compassionate health care system. “You can call it whatever you want. We’re going to take care of people,” he said.

He has also pledged to repeal and replace Obamacare with a system based on free-market principles such as open competition by providers and insurers. The price transparency he espouses has already led to lower prices in places like the Surgery Center of Oklahoma. He believes nationwide implementation would result in marked cost savings.

As with most Democrats, Clinton does not include as a health care “cost” what the government gives away in “free stuff” paid for by our tax dollars.

Another key cost-saving measure for Trump is lowering drug costs. He is pushing for Americans to pay the lowest negotiated rate that any of the other 33 countries in the Organization for Economic Cooperation and Development pay. This is crucial — and if it happens, it should result in hundreds of billions of dollars in savings to federal and state budgets as well as consumers and private insurers, if enacted within a year.

Clinton on Health Care
Hillary Clinton strongly defends Obamacare, but rejects the holy grail of her left-wing critics who are demanding a government-run, single-payer system. The closest she has come is her pledge to support a “public option” as part of the Affordable Care Act — which she has said she will make even more generous than it is today. That includes covering what she deftly refers to as “families, regardless of immigration status.”

She would allow illegal aliens to “buy into” the ACA exchanges. It is unclear whether that means they would also get the tax credit subsidies funded with the income taxes paid by citizens and others residing lawfully in the United States.

If we are not going to adopt “Medicare for All,” as Bernie Sanders calls it, and we’re not going to leave people completely on their own — what are the real and meaningful differences between Trump and Clinton?

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It Comes Down to Money
When you cut through the rhetoric, there is only one real difference — and it comes down to costs. Actually, it comes down to how costs are defined, as well as how much pharmaceutical costs will continue to drain our health care dollar.

In essence, Clinton seems to define health care “costs” as what we all pay directly for health care at the point of purchase — the cash that actually comes out of our pockets, or doesn’t come out of our pockets (for those who receive largely or fully subsidized government health care through Medicare or Medicaid). Yes, even Medicare is largely a freebie — a welfare program.

The Medicare premiums and taxes paid by workers and their employers cover only about 30 percent of the program’s real costs.

Medicare premiums and taxes paid by workers and their employers cover only about 30 percent of the program’s real costs.

As with most Democrats, Clinton does not include as a health care “cost” what the government gives away in “free stuff” paid for by our tax dollars. She also doesn’t seem to consider it a “cost” of health care if your employer has to pay more for your health insurance package — silently taking the same dollars out of your paycheck, leaving you with stagnant wages or reduced employment opportunities.  As with most other “progressive” economic policies, Clinton and other Democrats focus only on what is “seen” – not on the “unseen.”

She does give lip service to drug costs, but suggests a “fig leaf” — let Medicare “negotiate drug prices.” But the American pharmaceutical industry and Congress are too corrupt to make negotiation work.

We need a simple rule to apply to all Americans no matter what insurance they have. No one can charge Americans more for any prescription drug than the lowest price charged in any developed country, as Trump has espoused.

As with the famous iceberg that sunk the Titanic, most of our out-of-control health care spending is unseen by the average voter, even by “high information” voters.

The real costs are still there under the surface. Even if your personal taxes don’t immediately go up, they show up in higher deficits and increased taxes on American businesses that reduce our economic growth, cash wages, job opportunities, and global competitiveness.

Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC.

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