Health Care: Trump vs. Harris

Candidate Kamala Harris says her healthcare plans — “HarrisHealth” — are “for-the-people” and will “insure everyone in America.”  She attacks candidate Trump’s proposals saying he will take away care from millions of Americans and will “throw granny off the cliff.”

The two candidates have diametrically opposite answers for our failing healthcare system. Harris sees the solution as more government involvement and Trump wants to give patients more control.

Ignoring campaign-driven hyperbole and each side’s dire predictions for the other side’s plans, what do they propose and what are the likely effects?

Trump Healthcare Proposals

Continuing his MAGA theme, Trump’s plan is called Health Reform to Make America Great Again. He would repeal the Affordable Care Act (ACA, “Obamacare”); make insurance premiums fully deductible on federal taxes; allow insurance sales across state lines; and offer Medicaid block grants to the states. Clearly, he intends to reduce the federal footprint in healthcare.

The media has consistently touted the ACA as “popular” based on the millions of Americans who enrolled in expanded Medicaid. After all, it is free for many of them, so what’s not to love?! The ACA is not so popular with those who actually need medical care — they can’t get it. Fewer and fewer doctors are willing to care for Medicaid patients because of low payments and the regulatory burden.  Medicaid patients wait so long for care, they die while waiting, called death-by-queue.

When a patient with Medicaid dies in hospital, his family suddenly discovers government insurance isn’t so free. There is MERP, the Medicaid Estate Recovery Program, that allows the state to recoup the decedent’s medical expenses plus a large administrative fee from the surviving family, including putting a lien on the family home.

The repeal of ACA would significantly reduce Medicaid roles taking away insurance from several million Americans. A large but unknown number will restore their employer-provided insurance. Interestingly, repeal of ACA would increase access to care for tens of millions by the seesaw effect. As fewer people are enrolled in Medicaid, fewer dollars go to insurance companies, and more dollars become available to pay for care.

Trump plans to allow Americans to deduct health insurance premiums against federal income taxes. This would cause an infinitesimal reduction in federal revenue and give a large boost to the buying power of take-home pay. Approving the sale of insurance across state lines increases competition, driving down prices. With more money in their pockets and lower prices, Americans will have more health care options, such as direct-pay care.

Medicaid block grants to the states are a good idea on many levels. First, it restores the original Medicaid law which includes “Section 1801: Prohibition against any federal interference.” Medicaid was always supposed to be state-structured, not federal one-size-fits-all.

Second, states know their needs and resources better than Washington and can use Medicaid dollars more efficiently to deliver care, especially when relieved of the federal regulatory shackles.

Third, block grants stop the unremitting increase in both federal and state spending. Fourth, fewer healthcare dollars will be wasted on Washington’s BARRCOME — bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement.

Finally, some states may want work requirements, or different eligibility standards, or higher payment schedules. With block grants, they are free to tailor their programs for the specific needs of their state residents.

HarrisHealth

Kamala Harris would start by making increased ACA subsidies permanent. These increases were passed in 2021 to compensate for the loss of income due to federal mandatory lockdowns during CoViD. A sunset clause was built in so that when the mandates were rescinded (as they have been) the increases would also sunset. Harris wants to keep the increases despite the unnecessary extra spending. This is, after all, an election year.

Harris would accelerate Medicaid expansion, giving more people free … oops, no-charge, government insurance. At its height in 2022, 94 million Americans had Medicaid/CHIP coverage — 28 percent of the population of the entire country was enrolled in a program designed exclusively “to increase benefits under the Old-Age, Survivors, and Disability Insurance System.”

Harris has approved, but doesn’t publicize, the enrollment of illegals in Medicaid, starting with 100,000 children.

In her drive to insure all Americans, Harris ignores or refuses to accept the seesaw effect. The more she enrolls people in government insurance, the less care people get. She will accept a false facade of success —– zero uninsured rate — for the disaster of more Americans succumbing to death-by-queue.

Harris wants all Americans dependent on government insurance. Despite her current strategic, campaign-driven silence on Bernie Sanders’ exceedingly unpopular Medicare-for-All (M-4-All), single payer plan. For years, she has been a whole-hearted supporter.

M-4-All is a complete takeover of healthcare by the federal government. It abolishes all public and private insurance, except Tricare and Indian Health Service, and enrolls everyone in a single one-size-fits-all federal plan. Patients pay nothing, except in higher taxes, much higher taxes. The top rate in Sweden’s single payer, cradle-to-grave healthcare system is 52.2 percent.

With M-4-All that Harris will impose on us, Washington decides what care you get, when, where, by whom, and even if. Washington credentials, licenses, and punishes care providers. Woe unto physicians who oppose Washington narratives. Just as during CoViD, they will be censored, canceled, and fired.

With M-4-All, there will likely be a mass exodus of senior physicians. Then, who will care for today’s patients or teach tomorrow’s doctors?

In addition to her failure to accept the seesaw effect, HarrisHealth ignores fiscal impacts of her plans.

Expanded ACA subsidies nearly doubled the cost of benchmark private insurance premiums from $244 per month (2013) to $477 per month (2024). Medicaid expansion diverts more money to insurance companies and BARRCOME, leaving less for patients.

The Commonwealth Fund calculated that Trump’s healthcare plans could add as much as $41 billion to the national debt. The M-4-All that Harris wants to impose on us eventually will cost $40 trillion. In addition to bringing more death-by-queue to the U.S., HarrisHealth would cost 1,000 times more than what Trump proposes.

Voters: You choose.

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former director, New Mexico Health Insurance Exchange; and author of 12 books including the multi-award winning Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.  

READ MORE from Deane Waldman:

Wait Times for Medical Care Matter

There’s a Tiny ‘Bubble’ That Could Save Healthcare

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