The Candidates on Health Care

October 7, 2015

The Opinion Pages | EDITORIAL

The Candidates on Health Care


While the Republican presidential candidates have been busy railing against

Obamacare, the two leading contenders for the Democratic nomination have staked

out radically different ideas on how to improve the American health care system.

Hillary Rodham Clinton has proposed adding useful consumer protections to the

Affordable Care Act. Senator Bernie Sanders wants to create a single-payer system

that would essentially expand Medicare to cover people of all ages.

Senator Sanders’s bold call for “a fundamental transformation of the American

health care system” would look more like the plans in many other industrialized

nations that often achieve better health outcomes at lower costs. His home state of

Vermont flirted with the idea, but it dropped its plans because of fears that the high

costs would harm the economy. A national program could be more cost-effective, but

it has no chance of surmounting opposition from Republicans and from health care

industries that fear their profits would be cut.

Mrs. Clinton vigorously defends the Affordable Care Act and its reliance on

private insurance, but she would make important changes to protect people from copayments

and deductibles that have been rising faster than their wages. She would

create a new tax credit of up to $5,000 to help families pay high out-of-pocket

medical costs and would require insurers to cover three visits to the doctor each year

before people start paying to meet their deductible.

Both Mrs. Clinton and Mr. Sanders have taken strong stands against the

sometimes exorbitant prices for prescription drugs that manufacturers set with no

reasonable justification. Both would authorize Medicare to negotiate with drug

companies to drive down prices — a move now prohibited by law, at Republican

insistence — and both would allow Americans to import cheaper drugs from other

countries. Mrs. Clinton would cap a patient’s out-of-pocket drug spending at $250 a


The leading Republican candidates are unanimous in calling for repeal of the

health care reform law — Donald Trump has called it a “catastrophe,” and Jeb Bush

labeled it a “monstrosity.” Yet they are remarkably tongue-tied on how they would

replace it.

In the Sept. 16 debate among 11 Republican candidates, the issue came up only

obliquely. None of the Republican candidates have endorsed government negotiations

with drug companies; they believe private negotiations and competition among drug

companies are working just fine to curb drug costs.

Of the Republicans, only Senator Marco Rubio has sketched out an alternative to

the current health system. He would rely on tax credits of unspecified amounts to

help people buy private insurance — an approach that is comparable to what the

Affordable Care Act does now but that would most likely be less generous. He needs

to flesh out his plans and his competitors need to devise serious alternatives of their

own so that voters can see how they compare with a reform law that is working

remarkably well.

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A version of this editorial appears in print on October 3, 2015, on page A22 of the New York edition with the

headline: The Candidates on Health Care


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