What do Donald Trump and Bernie Sanders have in common? At first glance, not a lot. Sanders is far left; Trump is far right. Could any two candidates be more different?
But the similarities run deeper than one might think. Both are radical outliers who’ve deeply upset what was expected to be a fairly boring election. Both speak their minds without apology. Both have widespread support among voters across many demographics: Trump’s followers range from liberal to very conservative, covering the Republican mainstream, albeit slightly older, less educated and less well-to-do than average. Supporters of Sanders include moderates and liberals, men and women, those with and without degrees, people who own guns and people who don’t.
So how do their views on healthcare compare? What impact would a Sanders or Trump presidency bear on the American healthcare system? Let’s take a look.
Bernie Sanders and the single-payer system
The plan that Sanders proposed is called Medicare for All. That said, he is not suggesting a repeal-and-replace approach to the ACA. Rather, he wants to keep it intact while working toward a single-payer system.
The ACA “has been an important step forward,” Sanders said, “but we can and must do better.”
The details, according to his campaign website, include providing comprehensive coverage across “the entire continuum” of healthcare, allowing patients to choose their provider, reducing costs by standardizing rates and negotiating better drug prices, among other things.
He said his plan would save $6 trillion over the next ten years. It would save the average middle-class family over $5K per year; businesses, roughly $10K a year.
How would we pay for it? Employers would pay a premium of 6.2 percent of their income; households, 2.2 percent. Tax reforms, too, would offset costs.
Donald Trump and something terrific
It’s hard to pin down exactly what Donald Trump wants to do with healthcare. He hasn’t released a coherent proposal; rather he’s made a stream of positive statements that few could argue with (e.g., “Everybody’s got to be covered”) without spelling out a strategy.
What would he replace the ACA with? In his words: “something terrific.”
When questioned about Ben Carson’s plan to reallocate what we spend on Medicare and Medicaid into HSAs, he said, “I’m okay with the savings accounts.” Would it make Medicare unnecessary? “Well, it’s possible,” Trump said. He also said that Republicans should not cut Medicare.
What about the ACA? Trump said that Obamacare is a disaster and a lie and must be repealed, after which we will “need a plan to bring down healthcare costs and make healthcare insurance more affordable for everyone.” When interviewer Scott Pelley from 60 Minutes asked him how, he said, “I’m going to take care of everybody.”
In “The America We Deserve,” published in 2000, Trump wrote, “We must have universal healthcare.” That’s a view he still supports. But universal healthcare calls for greater taxes, and when Pelley asked him if he was going to raise taxes, his answers were contradictory: on one hand, he said that “some very wealthy are going to be raised.” On the other, he said, “Well, we’re not raising taxes.”
In short, while it’s easy to see what Trump’s plan will be like (“we’re going to have something that’s going to be spectacular”), it’s not so easy to see what the plan will actually be.
As we said at the outset, there are some striking similarities between Sanders and Trump. Both favor universal healthcare. Both promise to turn the system on its head. Both are unfazed by obstacles of partisan politics and financial naysayers. These similarities run deep enough to galvanize voters of all stripes. Yet at the end of the day, the differences run deep, too.
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