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Answer by Mitul Mehta, M.D., vitreoretinal (eye) surgeon at UC–Irvine:
The Republican plans are effectively nonexistent. They want to repeal health insurance for people who have it now, but some of them like the ban on pre-existing condition denials of coverage. This is morally reprehensible.
Hillary Clinton's plan is vague but I think it is in general the right way of thinking. There are many things wrong with the Affordable Care Act, but in particular:
- The high-deductible plans that don't cover anything other than catastrophic issues, which in reality should be the government's responsibility
- The lack of Medicare being able to negotiate drug prices (the VA can)
- Rising insurance costs (some people's premiums went up a lot)
- Health savings accounts shouldn't have to exist—all health expenditures should be tax-deductible
- New plans caused some people to lose their doctors
And Clinton's plan is to fix these things. Doctors don't like the ACA because it is resulting in dramatic reimbursement reductions for our services. One treatment I do got cut 66 percent recently. A few types of sight-saving or sight-restoring surgeries I do got reduced 20 to 30 percent (some of which takes hours and require extensive follow-up within the 90-day window that is included in these payments). That really sucks for me and will probably cost me around $50,000 this year (before taxes), which is a lot of money to me because my dad can't just “give me a small loan of $1 million.” So ultimately it means we will won't hire another person in our practice. But all that being said, I like the ACA. I think people should not be prevented from having health insurance because of a pre-existing conditions, and I think Medicaid needed expansion.
Bernie Sanders’ plan is Medicare for all. What he doesn't seem to understand is that it will quickly turn into Medicaid for all. It will not make the private insurance market disappear (just like it didn't in the U.K.), so many people's costs will go up because they will be paying taxes for the new system but will demand that their work provide private insurance that will allow them to see their doctor. It will make basically all doctors who don't work for the government drop Medicare, because they will be reimbursed less than their costs.
The government will have to spend a trillion dollars building new hospitals and buying medical real estate to provide doctors for all of the patients. The British have this system, and their doctors are striking. Basically doctors can't get a steady job for 10 years after residency and get forced to scrape by until a government job opens up.
Also the Republican House and Senate will never agree to this. They will scrap the ACA and not replace it.
It's funny because Sanders claims to be a democratic socialist like Europe, but they don't all have single-payer systems. Some have a universal insurance system like we do under the ACA, but I think most have a public option, which we should as well.
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