Healthcare policy was the central issue during the 2018 mid-term elections which led to the democrats winning a majority in the House of Representatives.  Among the leaders in the race for nomination for the democratic candidacy the common theme is, ‘affordable healthcare’.  The reason is clear. 95% of Americans say Medicare is important to them!  And no wonder. Approximately 18% of the American Gross Domestic Product (GDP – the value of all the goods and services produced each year) is spent, either by us or by the government, on HEALTHCARE.

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Every candidate has endorsed their own distinct health care policy. Bernie Sanders ‘MEDICARE FOR ALL’ is based on a ‘single payer’ concept which would abandon private health insurance plans altogether.  Mike Bloomberg espouses the concept of a PUBLIC HEALTH INSURANCE option run by the government to compete with private insurers and set standards in terms of both cost and effectiveness.

Pete Buttigieg’s healthcare policy has as its ultimate goal ‘universal coverage’, an aim he shares with Sanders. But Buttigieg’s approach is to expand Medicare access to ‘All Who Want It’ (it is currently only available to seniors, and adults with defined chronical conditions).

Buttigieg’s plan for expanding healthcare coverage through Medicare would begin by extending the public insurance option to: –

  1. Low-income individuals in states that have refused to expand Medicaid
  2. Individuals who forgo (sponsored) employer coverage because it is too expensive
  3. Middle-income individuals and families, uninsured because of cost. The intention is to offer subsidies on plans purchased either through the market place or the public option.

The Buttigieg healthcare policy will require drastic changes to the way in which the country divides the spend on funding the health of the nation. On our behalf the federal and state governments spend around $1.5 trillion (Medicare, Medicaid, other insurance programs, and subsidies).  We, the public, spend nearly as much again on co-insurances, co-pays, and deductibles.  In total, as nation we spend 18% of our income on healthcare. 

It is no wonder that ‘would be’ presidents devote so much of their time considering how to spend it and in persuading us that they have the best healthcare policy.

They do have a common goal: to provide accessible health care and consistent high standards of service to the whole US nation.  The word ‘accessible’ is a term which embraces both ‘affordability’ and the ‘geographic’ availability of the necessary services.

The questions is how?

We, the American nation, pay almost 2x the average among the top ten developed nations for our healthcare and on most measures our outcomes are less favorable.  We are neither more efficient nor more effective.

What are the solutions?

BERNIE SANDERS would introduce a universal program called ‘Medicare for all’ under which the benefits provided by Medicare Part A, Medicare Part B, Medicare Part C and Medicare Part D are combined in a single all-embracing healthcare policy called Medicare For All. Implicit in this healthcare policy is the concept of ‘the single payer’ i.e. the federal (state) government.  He argues that this will reduce the inefficiency of having multiple payers (the insurance companies) and multiple suppliers (the health care providers).  It would also reduce/eliminate the role of the health insurance exchanges.  Sanders wants to achieve this in single step. Most healthcare policy analysts, even those sympathetic to the concept, agree that to move from the current mix of public/private funding would be hugely disruptive.

Read more: Bernie Sanders Medicare for all explained

MIKE BLOOMBERG answers the same questions.  He sees value in private insurance and in the need for the security that public funding gives to disadvantaged members of society. He offers to deliver a Medicare level of service provision through an Affordable Healthcare Plan. This plan would be run by the Federal Government with premiums restricted to 8.5% of household income. His plan will be optional.  Those who wish to remain privately insured may do so. Bloomberg expects the cost of private insurance to decrease in the face of a major competitor in the market. Bloomberg offers a long term and sustainable choice for the individual to choose one, the other or a combination.

Read more: Mike Bloomberg’s Affordable Healthcare plan

PETE BUTTIGIEG, like Bernie Sanders, sees Health Care as a right. He has a long-term aim to move from private insurance to solely government-funded programs.  His approach is to offer the option of getting coverage though ‘a public insurance’ alternative.  In this way, Buttigieg hopes that if plans available to you from your employer or on the market place are unaffordable you can choose ‘the public insurance’ alternative and find a plan that is affordable. He distinguishes his position with the slogan ‘Medicare for all who want it’.  He makes no secret of the fact that he expects sustained competition from the public insurance ‘alternative’ to result in a ‘Medicare for all’ outcome.  He makes no prediction as to how long this will take.

THE THREE FRONTLINE CONTENDERS for the Democratic nomination plan to put constraints on the price of branded drugs, and to eliminate the exposure to high costs of unexpected medical bills from out of network providers such as anesthetists and ambulance services. In doing so they will have to battle not only with the House and the Senate but also with the reluctance of the pharmaceutical industry to adapt to new market forces and the task of re-orienting the focus of a workforce numbering 16 million.