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Healthcare 2020: Where the Presidential Candidates Stand

by Kent Bottles, MD

What do each of the three remaining candidates propose for the American health care delivery system?

Health care will be a deciding factor in who will win the 2020 American presidential election. Although Bernie Sanders could hypothetically catch up to Joe Biden in the delegate race, it now looks likely that the fall election will pit former Vice President Biden against President Donald J. Trump. The coronavirus pandemic that is currently turning American life upside down will only increase the importance of health care policy in the minds of voters this November.

So, what do each of these three candidates propose for the American health care delivery system? TLD Group Board Advisor, Dr. Kent Bottles, provides a summary of the candidate’s positions below.

President Trump’s health care policy has mostly been characterized by what he is against as opposed to a comprehensive plan. He has expressed a desire to repeal the Affordable Care Act, and his administration is currently arguing in federal court that the entire ACA should be overturned. The Supreme Court will not hear the case until after the November election, but if the administration is successful, pre-existing condition protections, premium subsidies, Medicaid expansion, and essential health benefits will all be reversed resulting in loss of insurance by more than 20 million Americans. The president has also proposed the following: converting the ACA and Medicaid into block grants, giving states the ability to require work requirements for Medicaid recipients, promoting short-term health plans that do not required coverage of the “required benefits” of the ACA, requiring strict guideline for immigrants to receive health benefits, prohibiting health care groups from making referrals for abortion, and requiring hospitals to disclose the prices they negotiate with insurance companies.

Vice President Biden has advocated for building upon the ACA by “adding a public option to Obamacare as the best way to lower costs and cover everyone.” Under Biden’s proposal every American would be able to “purchase a public health insurance option like Medicare.” He also proposes making the ACA subsidies more generous by reducing the amount of family income going to premiums, eliminating the cap on subsidies so more families would qualify, and making the current “Gold” plans rather than the “Silver” plans the benchmark. Biden also wants to eliminate surprise billing for situations (emergency surgery) when the patient cannot be expected to choose his physician, and he lists several measures to reduce the price of prescription drugs. Biden’s public option proposal is more generous than the original ACA program.

Even though Sanders looks to fall short of securing the nomination, in many ways he set the agenda for the debate with his “Medicare for All” bill that would cover all Americans automatically and eliminate most private insurance. Sanders’ call for universal health coverage that eliminates co-pays for physician visits and includes a benefit package that is more generous than what other countries like Canada, France, United Kingdom, and Germany offer. Sanders has been reluctant to spell out how he would pay for such a generous package, but he does come up with possible options such as a 4 percent income-based premium paid by employees, a 7.5 percent income based premium paid by employers, eliminating health tax expenditures, a marginal tax rate of up to 70 percent on Americans making more than $10 million, making the estate tax more progressive, and repealing corporate accounting loopholes. By proposing what some view as an extreme position, Sanders has moved the entire debate in a more progressive direction.

In the November election health care voters will have a stark choice. Trump would like to repeal the ACA and reduce the federal government’s involvement in health care. Biden is championing an expansion of ACA with a public option that might over time develop into a single payer system. Stay tuned for more blog posts from Dr. Bottles on this issue as the election nears.


Kb-1Developing strategies and tactics to successfully engage physicians in quality, leadership, payment reform, and change management has been the focus of Dr. Bottles' work for over 35 years.  He has extensive expertise in federal, state, and local healthcare delivery system reform.  Dr. Bottles currently teaches health care policy and payment reform to graduate students pursuing their Master of Science in Health Policy, Applied Health Economics and Outcomes Research, Public Health, and Healthcare Quality and Safety at The Thomas Jefferson School of Population Health in Philadelphia.  Dr. Bottles delivers 50 keynotes a year on topics ranging from:  Digital Medicine, The Science of Positive Psychology, Social Media, Change Management, Leadership for Chaotic Times, Big Data vs. Tiny Data, The Doctor/Patient Relationship for the 21st Century, and Activation and Engagement of the e-Patient.

Dr. Bottles currently serves as a TLD Group Advisory Board member and has held a number of physician executive positions over the course of his career, including Tenured Professor at the University of Iowa and Michigan State University College of Human Medicine, Assistant Dean for Grand Rapids at MSU, Chief Medical Officer of the Iowa Health Science, President and CEO of the Institute for Clinical Systems Improvement in Minneapolis, President and CEO of the Grand Rapids Medical Education and Research Center in Michigan, Chief Knowledge Officer and President of the Genomics Repository for a bio-tech startup, and Chief Medical Officer for a medical communications startup.

Interested learning more about TLD Group? Learn more about our Health Ecosystem oriented solutions here.

Kent Bottles, MD

Written by Kent Bottles, MD