The California presidential primary is just around the corner, and our top three presidential candidates have very different ideas about the future of health care. There is general agreement among them that health care needs more work. Where they differ is, though, is in the degree of work needed.

One candidate wants to kick the Affordable Care Act to the curb, like a useless couch. Another wants to keep the couch, but change the cushions. And the third wants to keep the couch, but upgrade it so that everybody can comfortably sit on it.

But before we get into the candidates’ positions on health care, we really need to ask “how much power to change health care will the next US President actually have?” The answer is: Not as much as you might think.

That’s because this year’s presidential election is unusual in ways that may profoundly influence the future of healthcare reform. Let’s look at presidential power, in general, and then at our current presidential race –

The president’s powers in government are very specifically defined in the Constitution:

To serve as Commander in Chief of the Army and the Navy; to approve, veto and/or execute legislation (not initiate it); to set foreign policy; to appoint key personnel, like judges, ambassadors and officers of the US; to present the State of the Union; to pardon felons.

In addition to these constitutional powers, the President has implied powers, powers granted by Acts of Congress, and “soft” power – or influence – that comes from being the president. For example, an elected president is considered the head of his or her political party, which offers her or him the opportunity to influence legislators in Congress who share the same party affiliation.

So when considering “how will the new President impact health care,” it’s necessary to first keep in mind the gridlock and partisanship that has characterized the US Congress for the past eight years!

But there’s more to consider. This presidential race is highlighting the fact that many Americans – especially (but not solely) younger Americans –no longer feel loyalty to one party or the other. In fact, two of the presidential candidates lack strong ties to their political parties that may make it difficult for either of them to influence legislators that is, to use their “soft” power over the legislature.

The third presidential candidate, on the other hand, has strong ties to her party, but reportedly has some trust issues, especially with American youth, which may affect her influence with the general public.

All this is why HEAL California does not look to the Federal government to take the lead on healthcare reform. Instead, we look to state governments including Colorado, New York and of course, California! Learn more about our take on how to get this done, following Canada’s experience, here: State-by-state, lessons from Canada

Moving on beyond this sad exercise in curbing expectations, now let’s take a look at the highlights of each candidate’s health care agenda and how Americans feel about the three plans (based on polling).

Donald Trump’s plan, in a nutshell, calls for repeal of Obamacare and a “free” market in health care. From the perspective of public health, repealing Obamacare would represent a major disaster for millions of us. Even though Obamacare has left 30 million Americans uninsured and another 30 million of us underinsured, repealing it would harm the 17 million people who gained health insurance under it. 

And if you think it’s realistic to think of health care as a commodity, read our article Health care is not a couch.

Hillary Clinton’s plan is to “defend” Obamacare from being repealed, and mildly tweak it. One big problem with her plan is that it preserves some of the worst aspects of Obamacare. For example, she concedes that premiums, deductibles and out-of-pocket costs are too high under Obamacare, with devastating impact on patients, especially those with cancer and expensive ailments. But instead of regulating health insurers and healthcare providers to reign in costs, she proposes tax credits – on top of the tax credits Obamacare already introduced. By the way, just how complicated can we make our income taxes, anyway? Wasn’t it fun filing your taxes this year? NOT.

What’s infuriating is that, just like with the fossil fuel, firearm and cigarette industries, the fiscal harm caused by the healthcare industry would be absorbed by you and me – the taxpayers. See, tax credits support the appearance of affordability, without truly affecting affordability in any meaningful way.

Bernie Sanders’ plan, on the other hand, is to strengthen Obamacare so as to leave no one behind. Integrating health care across the country and expanding it to include everyone would cost quite a bit of money, as you can imagine. But paying for this is actually quite easily done – in two simple ways.

Instead of paying premiums to health insurers, and deductibles, co-pays and coinsurance to doctors and hospitals, everyone would pay a small tax on payroll. This would be fairer because instead of paying fixed premiums, people would pay based on their income.

But perhaps most important – and most consistently ignored by the corporate media – are the savings that would be realized by eliminating the unnecessary administrative complexity of having hundreds of insurers and thousands of different kinds of plans. We are talking billions of dollars! Learn more about reducing healthcare costs here: The US Economy is Finger-Lickin’ Good

By far, Gallup polls show that the most popular plan of the three is the Bernie Sanders plan. Here are the results of a May, 2016 poll:

Favor or Oppose Three Proposals Relating to the Affordable Care Act

Please tell me whether you strongly favor, favor, oppose or strongly oppose each of the following.

	Favor%	Oppose%	No opinion%
Replacing the ACA with a federally funded healthcare program providing insurance for all Americans	58	37	5
Repealing the Affordable Care Act	51	45	3
Keeping the Affordable Care Act in place	48	49	2
Gallup, May 6-8, 2016

So, what now? Well, the two most important things you can do are to get the facts about health care, and vote! Now is the time to do your homework. The California primary is coming right up on June 7 and it’s your future that’s at stake.

P.S. Join HEAL California for news and updates on health care! You’ll be glad you did.