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[This is the second post in a series on the health plans of the 2016 presidential candidates. Part 1, which looked at Bernie Sanders’ health plan, is here.]

Here’s what the 2016 Democratic candidates for president agree on: They agree that healthcare in America is better since the Affordable Care Act. They also agree that there are still problems that need to be fixed, and they mostly agree on what those problems are– a list that looks pretty similar to one we made a while back:

  1. We still don’t have universal coverage;
  2. Unaffordable out-of-pocket costs;
  3. Buying and using insurance is incredibly confusing;
  4. Narrow provider networks;
  5. Price-gouging by providers;
  6. Lack of dental coverage; and
  7. Drug discrimination by insurers.

Where they differ is on how to fix them. Bernie Sanders proposes a totally new system: one single-payer plan covering everyone. As we’ve said before, it could be a great idea, potentially solving every problem on that list (and then some) all at once. Still, single-payer doesn’t automatically mean that people would be better off. For example, if we simply moved everyone into traditional Medicare, which is a single-payer plan, most people would end up with higher out-of-pocket costs, and its low reimbursement rates could force providers out of businesses. To judge any plan– single-payer or otherwise– you have to look at how it balances benefits and costs; and in Sanders’ plan those key details are a mess.

Hillary Clinton’s approach on the other hand is to build on the ACA. Clinton doesn’t provide detailed cost estimates for her proposals, but they’re all small enough changes that it’s easy to imagine how they might be paid for. In a way though, this also highlights a problem: even if all of her proposals were in place, the major issues with our health system would still remain. In other words, unlike Sanders’ plan, the numbers add up– but they don’t add up to nearly enough. [continue reading…]


The fuzzy math behind Bernie Sanders health plan

bernie sanders

[This is the first post in a series on the health plans of the 2016 presidential candidates.] 

Even before they released specific plans, it was obvious that Bernie Sanders and Hillary Clinton had very different philosophies for improving our health system. Clinton promised an incremental approach: new regulations and funding to fix issues that Obamacare missed, but otherwise keeping the current system. Sanders proposed something much more radical: eliminating private insurance entirely, and covering everyone under one single-payer system.

It’s a great idea in theory: everyone gets an insurance card that they can take to any doctor or hospital in the country. No more worrying about whether you have insurance, whether a provider is in-network, or whether your claim will be denied. Single-payer also saves money thanks to lower administrative costs– hospitals don’t have to bill hundreds of different insurance plans, each with their own rules– and by negotiating for better prices from drug companies. Canada and a few other countries have shown that a national single-payer plan can work; they spend much less per person on care than us while covering everyone.

The hard part is figuring out how to get there from our current system. To switch to single payer you need to (1) figure out what services will be covered for every single American, keeping in mind that every benefit makes the plan more expensive; (2) set taxes and out-of-pocket costs so they’re affordable for every family; and (3) decide what to pay providers (set prices too high and the system is too expensive to sustain, set them too low and you force some doctors and hospitals out of business). Balancing all these variables is tricky, especially since the numbers are enormous. Over the next ten years we’re expected to spend over $40 trillion on health care, so a few percentage points here or there can mean the difference between a working system and an economic crisis.   [continue reading…]


The Health of the Union 2016

obama state of the union 2016

For his final state of the union, President Obama said he’d go easy on the traditional list of proposals for the year ahead. Instead, he said, he wanted to talk about “the next five years, the next ten years, and beyond.”  And so, while he talked about the programs enacted during his time in office– including, of course, Obamacare– and the issues he’ll work on during his last year, but he didn’t lay out much in the way of specific plans. Still though, the health issues he talked about were telling, and there were some surprises.

Here, for the last time under an Obama White House, is our annual look at healthcare in the State of the Union.   [continue reading…]


john bel edwards

If you really think about it, the politics surrounding the Affordable Care Act have always been weird. The ACA was modeled on Massachusetts’ health reform, which was signed into law by future Republican presidential candidate Mitt Romney and supported by conservative think tanks like the Heritage Foundation. It’s also very similar to a plan proposed by Republican senators as an alternative to President Clinton’s health reform efforts in the early ‘90’s. So in theory, Republicans should have had no problem with Obamacare. Instead, Romney, the Heritage Foundation, and every other Republican in Congress came out against it.

But lately the politics of the ACA have gotten even stranger.

There are basically two parts to Obamacare’s coverage expansion: (1) Medicaid for those with incomes below 138% of the federal poverty line, and (2) exchanges where anyone who isn’t covered by an employer or government program like Medicare can purchase private insurance. Of the two parts, you’d think that Republicans would want to see more people enrolled in private insurance and fewer people enrolled in a big government health plan like Medicaid.

Yet, over the past month, we’ve seen Republicans across the country push to expand Medicaid, while their colleagues in Congress work to blow up the ACA’s private insurance expansion.   [continue reading…]



Even among supporters of the Affordable Care Act, the law’s “Cadillac tax” on expensive employer-provided health plans has never been popular. Unions hate it because in many cases it will be their members’ health plans that are hit, and all three Democratic presidential candidates have called for its repeal. Meanwhile, on the other side, big corporations don’t like it either, since it could force them to choose between cutting back on benefits or paying more for healthcare, and a number of prominent Republicans, like House speaker Paul Ryan, want to repeal it as well.

Really it seems like the only people in favor of the Cadillac tax are economists– but they really like it. One hundred and one economists signed an open letter saying that it will lower health spending and asked Congress to “take no action to weaken, delay, or reduce the Cadillac tax until and unless it enacts an alternative tax change that would more effectively curtail cost growth.” It was signed by economists from across the political spectrum– everyone from the right-leaning American Enterprise Institute and former Bush administration officials to the left-leaning Center on Budget and Policy Priorities and former Obama advisors.

Usually if there’s a fight with a huge bipartisan group of policy wonks united on one side versus politicians and special interests on the other it’s a no-brainer: go with team wonk. But on this issue, we’re not so sure– it seems like the economists might actually be on the wrong side of this one.   [continue reading…]


Obamacare info table

It’s open enrollment time for the Affordable Care Act, which means that now through January 31 anyone who needs coverage can buy a plan. The ACA means that millions more Americans can get affordable coverage, but shopping for health insurance can still be incredibly confusing and stressful. Don’t worry though: to help make the process a little easier, we have a new guide to getting covered under Obamacare for 2016!   [continue reading…]


Surprisingly this guy, Martin Shkreli, is not a great person.

Hey, it’s been a while! Sorry for being MIA recently– we’ve been working on a big project for another, non-healthcare site. Luckily late summer is usually a slow time for health news, and this year was no exception. In what’s becoming an annual tradition, some journalists freaked out about proposed Obamacare rate hikes, but it’s still too early to say what rates regulators will approve in most states (they will almost certainly be lower). Some of the 2016 presidential candidates released health plans, but with the election over a year away, it’s too early to pay much attention (for example, Scott Walker, who put out one of the more detailed plans on the Republican side in August, has already dropped out).

There was one story that caught our attention though: a small startup jacked up acquired a drug used to treat life-threatening infections in AIDS patients, and jacked up the price by 5,000% overnight. It touches on the biggest problems with the prescription drug industry, and the outrage that ensued might even generate enough momentum to fix some of them.   [continue reading…]


Can healthcare be cured of racial bias?

Maria Smolnitcaia, 52, is a singer living on a TB ward in Balti, Moldova. Smolnitcaia says "When we take the pills, we feel worse. I'm losing my hearing a little. I feel pain in my bones, in my whole body."

Last month marked the anniversary of the shooting of Michael Brown by a police officer in Ferguson, Missouri, and with it, the birth of the Black Lives Matter movement. Since then, we’ve seen time and again how the conscious and unconscious biases of police officers mean that black Americans are disproportionately targeted and much more likely to be killed or injured by the police.

But interactions with law enforcement aren’t the only time racial stereotyping can lead to injuries or even death for people of color. As this excellent article by April Dembowsky of KQED (in partnership with Kaiser Health News and NPR) illustrates, in medicine too, the unconscious biases of doctors are a major factor in the disparity in treatments and outcomes between white patients and black and Latino patients– a gap that new training programs hope to address.   [continue reading…]


first Republican debate 2016

For the most part, in last week’s GOP primary debates there wasn’t much we haven’t already heard about healthcare. Candidates promised to repeal Obamacare, none offered a plan to replace it. They said they would defund Planned Parenthood (and of course none pointed out that the organization isn’t actually selling baby parts). Former Arkansas governor and Fox News host Mike Huckabee repeated Mitt Romney’s wildly misleading claim from the 2012 election that Obamacare robs $700 billion from Medicare. In the undercard debate, Louisiana governor Bobby Jindal cited the same flawed Oregon Medicaid study we’ve covered before.

There were, however, three interesting moments.   [continue reading…]


In response to a series of undercover videos taken by anti-abortion activists posing as medical researchers, Republicans in Congress quickly pushed for a vote to strip Planned Parenthood of federal funding. The vote failed in the Senate, but as the Washington Post reports, the fight is far from over:

Defunding Planned Parenthood is now a centerpiece of the Republican agenda going into the summer congressional recess, and some hard-liners have said they are willing to force a government shutdown in October if federal support for the group is not curtailed.

Since clearly the issue isn’t going away anytime soon, here’s a serious question for Congressional Republicans and other anti-abortion activists: what is it from the videos that disturbs you about Planned Parenthood?

Is it the fact that Planned Parenthood is making aborted fetal tissue available to researchers? That’s perfectly legal, thanks to legislation that members of both parties– including some who are now spearheading the movement to defund Planned Parenthood– have supported; and most religious leaders, ethicists, and most of the American public consider it moral, regardless of their stance on abortion. Is it that the organization seems to be selling fetal body parts for a profit? The unedited videos actually show the opposite.

Or is it simply that Planned Parenthood provides abortions? Because, even if you’re opposed to that aspect of their work, the majority of the services they provide– and the only family planning services for which they receive federal funding– are meant to reduce unintended pregnancies that end in abortion.   [continue reading…]

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