Kamala Harris has adapted her health policy away from Medicare for All, aligning it more closely with the expansion of the Affordable Care Act. Donald Trump said he had notions of a health plan. Nearly 80% of voters consider health care at least very important in the upcoming election, according to a recent poll. Gallup poll.

What will candidates propose for Medicare, Medicaid, abortion and private employer-based insurance – and what crucial element are they overlooking?

Medical help

Medicaid is the joint federal-state safety net insurance program. A Trump administration would likely seek reduced Medicaid funding, stricter eligibility requirements and potentially a repeal of the Affordable Care Act. This would mean fewer fees, lower enrollment and reduced spending. A Harris administration would focus on expanding coverage, increasing access, and promoting equity. Traditional debates over taxes, rights and costs remain divided along political lines

Does the 805 billion dollars is the price justified?

Coverage does not equal access. In my practice, I am fortunate to be able to care for patients regardless of their financial ability, but treating Medicaid patients is considerably more difficult. Their doctor visits are often capped each year, they have fewer preoperative and postoperative resources, and they face greater barriers to obtaining images and medications. Managed care increases administrative burden. Big data from the registry of Andrew Chan MD, a neurosurgeon professor at Columbia University, indicates that Medicaid patients experience worst results following spinal surgery. While Trump advocates reduced funding, Harris promotes fairness.

In Alabama, if Medicare pays for a doctor $1 for one procedure, Medicaid pays $0.72, while private insurance pays $1.43. This arithmetic complicates the delivery of care.

Deep dive here.

Private insurance

In the United States, 57 percent of Americans under 65 are insured by their employer.

This system, stemming from wage laws dating back to World War II, hampered real wage growth as health insurance costs rose. annually.

Trump’s intentions to repeal the ACA remain unclear, as do his plans for a replacement. Harris withdrew from Medicare for Allpost she co-sponsored in 2020 alongside Bernie Sanders. She hasn’t needed to address the issue from the left this cycle, having skipped a primary election.

Improving subsidies in the ACA market presents a more pragmatic problem. In 2021, Democrats removed the old income cap and increased the amount of subsidies. These subsidies are set to expire in 2025. Harris advocates making them permanent, with a price tag of $335 billion, while Trump has remained largely silent, although many Republicans favor expiring the program.

Regardless of the ACA’s perspective, it’s important to note that health insurance is still more expensive than ever. The cost curve may be slightly curved, but the average cost of health insurance for a family of four was $23,968 in 2023. UnitedHealth Group’s net profit in 2023 was $22.4 billionup 11.2% from last year.

Deep dive here.

Abortion

If you prefer better access to abortion, vote for Harris. If you want the chance of laws being passed at the state level to restrict abortion, vote for Trump.

From a policy perspective, Harris argues for a return to Roe v. Wade, a position aligned with 60% of voters. Trump’s policies emphasize making abortion a state-level issue. Trump’s opinion on the issue has fluctuated; it currently supports limits of around 15 weeks, in a broader line public sentiment on abortion itself. Harris’ previous record on abortion is more progressive and less in line with that of the United States. She supported the Reproductive FACT Act, which required pregnancy centers to notify clients about abortion services (overturned in 2018 on First Amendment grounds), and voted against measures to protect infants surviving procedures abortion and to restrict abortions after 20 weeks. Only 22% of Americans support abortion in the third trimester.

Harris supports eliminating the filibuster to codify Roe, although it depends on Democratic control of Congress. Trump appears comfortable with the idea of ​​delegating abortion laws primarily to the states.

Deep dive here.

Health insurance

Trump and Harris perpetuate illusions about Medicare. Trump claims to protect it, but his budget proposals suggest otherwise. Harris’ plans to create new entitlements, financed by increased taxes and so-called savings, appear fiscally untenable. Faces of Medicare insolvency by 2036.

Harris recently touts home health care coverage with a price tag of 40 billion dollars per year. Mia Ives-Rublee and Molly Weston-Williamson of the Center for American Progress Action State adding this would revolutionize healthcare in America; it would help families, communities and the economy. Michael Cannon of the Cato Institute presents it as one; “irresponsible proposal.“Something else will have to be reduced or taxes raised considerably.

Some progress has been made in drug price negotiations. The Biden-Harris administration has allowed Medicare to negotiate prices, with reductions expected by 2026, a long-stalled goal. Republicans fear this will stifle R&D. Trump has not clarified his position.

Deep dive here.

What are candidates missing?

Health spending has reached levels that defy fiscal prudence, but the money for health care is not going to those who provide it. Medical services represent only 14.5% health expenditure.

From 1975 to 2019, the number of physicians increased by 150% while the number of health care administrators increased by 3,200%. The salaries of hospital executives have jumped 93% over a decade with an average pay gaps hospital CEOs are 5:1 to surgeons, 12:1 to pediatricians, and 44:1 to nurses.

THE mean deviation The salary between a hospital CEO and a surgeon is 5:1, that of a pediatrician is 12:1, and that of a nurse is 44:1.

Neither candidate addresses a return to the fundamental principle of health care: the patient-doctor relationship.