Healthcare Deserves More Attention in Campaign
Saturday, September 24, 2016 at 3:24PM By The New York Times
The reaction to opening a medical bill these days is often shock and confusion — for the insured and the uninsured. Prices and deductibles keep rising, policies are drowning in fine print, and doctors are jumping on and off networks. So why hasn’t the growing burden of health care gotten more attention in the presidential campaign?
One reason may be the sheer complexity of the system. Yet Hillary Clinton, if you look closer at her proposals, has a range of interesting ideas on how to tackle costs and improve care. Donald Trump, meanwhile, rarely ventures beyond his “end Obamacare” slogan.
With incomes for most Americans stagnant, individuals and families insured under the Affordable Care Act or through employers are bearing more of the cost of medical treatment.
Since 1999, premiums for family health plans have grown much faster than inflation and wages.
Deductibles for individual coverage increased 63 percent on average, to $1,221 per year, from 2011 to 2016 for people who gethealth insurance through their employers, according to a report released last week by the Kaiser Family Foundation and the Health Research and Educational Trust. Workers’ contributions to premiums grew more slowly than in previous five-year periods but still jumped 23 percent, to $1,129 a year. By contrast, average incomes were up just 11 percent, which means many people are being forced to cut back elsewhere to pay for care. And some people are choosing to forgo or delay going to doctors and hospitals when they are sick.
The cost of prescription drugs is another big problem for people with or without coverage. The average price of brand-name medicines jumped 164 percent from 2008 to 2015, according to Express Scripts. And 24 percent of Americans find it very or somewhat difficult to afford prescription drugs, according to a 2015 Kaiser Family Foundation survey.
Mr. Trump seems oblivious to these trends. His sparse health care proposal is built around a repeal of the Affordable Care Act, without any regard for the millions of people who would be hurt by that change. Twenty million Americans have gained health care coverage in the six years since the law was passed, bringing the uninsured rate to a record low. The law has problems — for example, there are too few insurers offering coverage on the health exchanges in rural and suburban areas — that the next president and Congress will need to fix. But it is generally working effectively and has cost the government less than expected, according to the Congressional Budget Office and the staff of the Joint Committee on Taxation.
Mr. Trump says he would replace the law’s subsidies and Medicaid expansion with tax deductions for health insurance premiums paid by individuals and families. But that would primarily benefit the rich, not the millions of low-income and middle-class people who would lose coverage if the law were dismantled. Mr. Trump’s plan also includes several vague ideas for lowering costs. One of them is to increase competition among pharmaceutical companies, but Mr. Trump does not say how he would do that.
Mrs. Clinton clearly understands the issues and has someplans that could help. Deductibles and other out-of-pocket costs have risen for workers covered by employer-based plans as businesses have shifted more costs onto employees. Mrs. Clinton wants to provide a tax credit of up to $5,000 to help people pay out-of-pocket costs, including for prescription drugs. That’s a good idea, but it would be even better if people received assistance when they faced expenses rather than when they filed their tax returns.
Another proposal from Mrs. Clinton would lowerprescription drug costs by allowing Medicare to negotiate with pharmaceutical companies. Drug makers, of course, hate this idea because it would reduce their revenue, and they would surely lobby Congress to defeat a bill. She has also suggested ways to lower costs by hastening the arrival of generic medicines. And she has promised to provide detailed policies to reduce needless medical procedures and to root out fraud and inefficiencies, moves that could prove effective in the longer run.
Health care is just the kind of difficult subject that presidential candidates ought to talk about more. If Mrs. Clinton were to speak regularly and in more detail about her health ideas, she could start building support for them with lawmakers and the public. She would also further expose the shallowness of Mr. Trump’s agenda.
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