By Jason Searle
U-M Law
What do presidential candidates Donald Trump and Bernie Sanders have in common? According to Professor Nicholas Bagley?, they’ve got unrealistic plans for sweeping reforms to the health-care system. During a talk at Michigan Law, Bagley explained how their health care plans, as well as Hillary Clinton’s, measure up economically, politically, and logistically.
Bagley said Trump’s plan focuses on health savings accounts (HSAs), tax breaks for the insured, state-controlled Medicaid, and more. In this, it resembles plans of other leading Republican candidates, notwithstanding some of Trump’s public statements in which he appeared more sympathetic to the uninsured. But Trump has bigger problems than appealing to a broad voter base to worry about. His biggest problem, Bagley said, is that Trump offers nothing to keep people insured who have started receiving benefits under the Affordable Care Act (ACA, also known as Obamacare). Retracting benefits in such a way would be very unpopular and politically challenging, Bagley said.
Of Sanders’s plan, Bagley said, “there are two major possibilities from the Democratic side. Sanders’s plan is simple: Medicare for all,” he said in reference to the single-payer plan, in which private insurance is eliminated and the federal government becomes the sole insurer of all Americans. People over the age of 65—the demographic creating the greatest financial strain on the health care system—already receive government insurance with Medicare. So it should be easy to throw everyone else on the single-payer train with grandma and grandpa, right?
Not quite, Bagley explained, jotting the numbers on the board to show that a single-payer plan would cost the federal government $1.4 trillion annually, resulting in $14 trillion in expenses over a 10-year period. In comparison, the cost of the ACA was less than $1 trillion over a 10-year span. “So Sanders’s plan is 14 to 15 times more expensive,” Bagley pointed out. Although the elimination of employer-sponsored insurance would lead to increases in take-home pay, taxes would have to increase to unprecedented levels in order to cover those costs. Ultimately, Bagley explained, a single-payer system is a pie-in-the-sky hope unless you are Canada, England, or another country of the like and started out with a single-payer scheme when health care was a small industry. With the demand for health care higher than ever, a quick transition to a single-payer system doesn’t appear to be politically feasible, he said.
The second major possibility from the Democratic side is backed by Clinton: build on the ACA. Clinton plans to augment the ACA in three main ways: 1) target rising prescription costs, 2) regulate cost-sharing and reduce out-of-pocket expenses, and 3) keep reducing the pace of health care spending. Bagley said the plan is the most realistic of all the major-party candidates’ proposals, but it’s also the least transformative.
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