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

2016-10-18 · explainer · John · 9:40 · watch on YouTube

Topic: US politics & society · mode: News analysis · tags: timely hook, civic or action cta, self promotion

John explains the pre-ACA US health system and what the ACA did and did not fix, then, using RAND's analysis, says Trump's plan would insure fewer people at higher out-of-pocket cost while Clinton's would insure more but raise the deficit more; neither would likely cut overall costs.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Greeting; recommendation of Healthcare Triage

  • ★ John recommends Healthcare Triage, hosted by Dr. Aaron Carroll, to anyone interested in health care or health, calling it an amazing show. — 00:00:04

00:00:11 — The US health care system in 2008 and its three problems: uninsured, cost, outcomes

  • ★★ John says that in 2008 most Americans got insurance through private companies, Medicare covered the elderly, Medicaid many low-income families, and about 15% had no insurance. — 00:00:18 · United States
  • ★★★ John says the US health care system in 2008 had three huge problems: many uninsured people, costs that were too high, and outcomes that were not particularly good. — 00:00:32 · United States
  • ★★ John says that before the ACA many people not working for big companies, including himself, literally could not buy health insurance at any price, because insurers could deny pre-existing conditions. — 00:00:38
  • ★★ John says that in 2008 the US spent 16% of its total economic output on health care, while most other rich nations spent under 10%. — 00:00:57 · United States
  • ★★ John says US health costs were so high that more tax dollars per capita went to health care than in Germany, Japan, the UK or Canada, all of which had universal publicly funded care. — 00:01:03 · United Kingdom, Canada, United States
  • ★★ John says that despite this spending the US did not get particularly good outcomes and was not near the top by almost any measure, from life expectancy to preventable hospital admissions. — 00:01:23 · United States

00:01:37 — What the ACA did: Medicaid expansion, exchanges, subsidies; partial implementation, results, remaining problems; ACA not the cause of high costs

  • ★★ John says the Affordable Care Act was designed to address some of these problems, with the emphasis on 'some', and primarily to get more people health insurance. — 00:01:37
  • ★★ John says about half the newly insured were to get Medicaid, expanded up to 138% of the poverty line, and half subsidized exchange insurance (up to 400%) regardless of pre-existing conditions. — 00:01:47
  • ★★ John says the ACA also sought to cut spending by lowering costs within Medicare and raised some new taxes, including one on medical devices, but left the rest of the system largely unchanged. — 00:02:10
  • ★★ John says the ACA was never fully implemented because a 2012 Supreme Court decision made the Medicaid expansion optional; nineteen states have declined it, leaving millions of poorer Americans uninsured. — 00:02:22
  • ★★★ John says the ACA has succeeded in reducing the number of uninsured people, to around 9.1% today. — 00:02:34
  • ★★ John says the ACA may have helped slow health cost growth (experts disagree): costs rose by an average of 8% in the 20 years before 2008 and 5.5% in the last five years. (hedged) — 00:02:40
  • ★★ John says costs still rise faster than inflation and median weekly earnings, outcomes still lag, and US care remains far costlier than anywhere, though the gap with Europe has narrowed; the ACA was not designed to fix this. — 00:02:54 · Europe
  • ★★ John lists other problems: rising employer premiums and deductibles as employers cover a smaller share, fewer plans on some exchanges, and higher costs for former bare-bones plan holders under comprehensive-coverage rules. — 00:03:13

  • ★★★ John stresses that the US system's structural shortcomings are much older than Obamacare: the ACA is not why US health costs are so high, since they were very high before it. — 00:03:34 · United States

    “The ACA is not the reason our healthcare costs are so high”

00:03:50 — Donald Trump's health plan per RAND: repeal, block grants, cross-state sales, deductible premiums; insured, out-of-pocket, deficit

  • ★★ John bases his comparison on analysis from the RAND Corporation, which he describes as nonpartisan and widely considered centrist. — 00:03:53
  • ★★★ John says Trump would first repeal the ACA; Trump says he will ensure private insurers keep covering people with pre-existing conditions but has not said how. — 00:03:59 · Donald Trump
  • ★★ John says Trump would fund Medicaid through block grants, letting states run their own programs, which most analyses expect to involve many cuts over time. — 00:04:09 · Donald Trump
  • ★★ John says Trump would let insurers sell plans across state lines and make all premiums tax deductible; deductions, unlike credits, would mostly benefit high-income people. — 00:04:19 · Donald Trump
  • ★★★ John quotes RAND's conclusion that Trump's proposals decrease the number of insured, raise out-of-pocket spending for individual-market consumers, and raise the federal deficit compared to the ACA. — 00:04:34 · Donald Trump
  • ★★★ John reports RAND's estimate that about 19.7 million would lose insurance if the ACA were repealed, and about 20.3 million fewer Americans would be insured under Trump's plan overall. — 00:04:45 · Donald Trump
  • ★★★ John reports RAND's estimate that under Trump's plan average annual out-of-pocket costs per person would rise from about $3200 to $5700, due to less generous deductions and more bare-bones plans. — 00:05:05 · Donald Trump
  • ★★ John reports RAND's estimate that, with ACA taxes and Medicare savings repealed, the deficit would go up by about 5.8 billion dollars under Trump's plan. — 00:05:38 · Donald Trump
  • ★★ John adds that all nonpartisan analyses he could find agreed Trump's plan would reduce the number insured, increase out-of-pocket costs and increase the deficit. — 00:05:55 · Donald Trump

00:06:05 — Hillary Clinton's health plan per RAND: tax credit, lower premium cap, public option; insured, out-of-pocket, deficit

  • ★★★ John says Clinton would amend the ACA, first with a $2500 tax credit ($5000 for married couples) for health expenses over 5% of income, available to all incomes but more expensive than a deduction. — 00:06:05
  • ★★ John says marketplace premiums are effectively capped at 9.6% of income (a family of four must earn $96,000+ not to benefit); Clinton would lower the cap to 8.5% for most, at a cost. — 00:06:34
  • ★★★ John says Clinton would offer a public insurance option on the exchanges, open to anyone; it would probably be cheaper than private insurance by sharing Medicare's administrative costs and slightly cut the deficit. (hedged) — 00:07:02
  • ★★★ John quotes RAND that all the Clinton policies considered increase the number insured and reduce out-of-pocket spending; the tax credit alone would insure 9.6 million more people. — 00:07:25
  • ★★ John reports RAND's estimate that out-of-pocket costs would fall at all income levels, most for families earning $30,000-60,000, while the programs would raise the federal deficit by $90 billion. — 00:07:44

00:07:55 — Summary comparison; deficits in context; neither plan likely to cut overall costs; no simple solutions

  • ★★★ John summarizes RAND: Trump's plan means significantly higher out-of-pocket costs, fewer insured and a modestly higher deficit; Clinton's insures more people at lower out-of-pocket cost but raises the deficit more. — 00:07:55 · Donald Trump
  • ★★ John says the deficits must be seen alongside the candidates' budget and tax proposals: overall, the deficit would be trillions of dollars more under Trump's proposals than Clinton's. — 00:08:07 · Donald Trump
  • ★★★ John says neither proposal will probably significantly reduce the overall cost of US health care. (hedged) — 00:08:17
  • ★★ John says the Trump campaign's claim that selling across state lines will increase competition is deeply contested, and even the rosiest projections show little spending decrease. — 00:08:26 · Donald Trump
  • ★★ John grants a public option might put real price pressure on private insurers, but says single-payer health care would not magically fix US problems, pointing to a link in the description. (hedged) — 00:08:35 · doobly-doo
  • ★★★ John says health care is a complicated, multifaceted problem; anyone selling simple solutions probably isn't telling the whole story, himself included, and this video is only an introduction. (hedged) — 00:08:46

00:08:56 — Healthcare Triage plug; sources and voting information in the description

  • ★★ John again urges viewers to check out and subscribe to Health Care Triage, which has a video on Medicaid's return on investment and will analyze the candidates' plans next week (week of 24 October 2016). — 00:08:57
  • ★ John points viewers to sources and information on how to vote in the video description. — 00:09:12 · doobly-doo

00:09:15 — Sign-off and end screen: related videos, tax-policy video, Rosianna's bunny

  • ★ Signing off, John says he will see Hank on Friday unless Hank has a child in the meantime. (playful) — 00:09:15 · Hank Green

In the description and comments

  • ★★ John adds that a single-payer system would not by itself bring US health costs down to 10% of GDP, citing Aaron Carroll's explanation. — video description
  • ★ John recommends the Commonwealth Fund's tool comparing side by side what Clinton and Trump propose for the health care system's problems. — video description · Donald Trump
  • ★★ John points viewers to How to Vote in Every State to find out how to vote in their state. — video description · How to Vote in Every State
  • ★ John thanks Rosianna for the graphics and Aaron Carroll for fact-checking, adding that any errors are his own. — video description · Rosianna Halse Rojas

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Affordable Care Act · Donald Trump · Donald Trump health care plan · government budget balance · health care prices in the United States · Hillary Clinton · Hillary Clinton health care plan · Medicaid · Public option · RAND Corporation · United States

Also: Projects: Healthcare Triage

Organizations: Supreme Court of the United States

Terms: doobly-doo

Concepts: block grant · competition (economics) · employer-sponsored health insurance · gross domestic product · inflation · life expectancy · pre-existing condition · tax credit · tax deduction · underinsurance · universal health care

Places: Canada · Europe · Germany · Japan · United Kingdom

Events: United States presidential election

Policies: Health insurance marketplace · Medicare · National Federation of Independent Business v. Sebelius

Only in the description or credits: Aaron Carroll · How to Vote in Every State · Rosianna Halse Rojas · The Commonwealth Fund

Also centred on Affordable Care Act: Adorable Puppy Explains Health Care Bill · Bigger Pizzas: A Capitalist Case for Health Care Reform · The Lowdown on the Shutdown · Applying for Health Insurance: Then and Now · Is Obamacare Working? The Affordable Care Act Five Years Later · Why Can't America Have a Grown-Up Healthcare Conversation?

Also centred on government budget balance: Hey! You! Fix the Budget! · Understanding the National Debt and Budget Deficit · Understanding the Financial Crisis in Greece · Understanding the Tax Plans of Donald Trump and Ted Cruz

Also centred on health care prices in the United States: The Political Situation at the County Fair · Health Care Reform Thought Bubble · The 1200% Increase in my Prescription Drug Costs · Question Tuesday! Paula Deen Riding Me (and critical reading) · Why Are American Health Care Costs So High? · Is Obamacare Working? The Affordable Care Act Five Years Later

Also centred on Hillary Clinton: Nerdfighting in 2008, Pakistan, and Hillary Clinton · Obama Says Subscribe · VEEPSTAKES! · Benghazi: Explained · Clinton vs. Sanders: POLICY IS EXCITING! · Understanding Donald Trump and Hillary Clinton's Tax Plans

Also centred on Medicaid: My Governor is Weirder than Yours

Also centred on Public option: Health Care Overhaul Summarized Via MASSIVE PIG · Health Care Reform Thought Bubble · Health Care Reform: The Hank Factor

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