THIS TIME ON CODE WACK!
As the United States faces an election possibly unlike any other in our history, we wonder about the future of our healthcare system. What changes might we expect under President Trump, or President Harris? What would a new administration mean for single-payer efforts in states like California and Oregon? And what about Medicare, a lifeline for so many vulnerable Americans?
To find out we spoke to the one and only Michael Lighty, president of the Healthy California Now coalition and former healthcare constituency director for Bernie 2020.
SHOW NOTES
WE DISCUSS
So we’re gonna talk about the future today! What can people expect on the healthcare front if Donald Trump is reelected?
“Well … <laugh> consulting my crystal ball … we’ve spoken, you know, about SB 770 and the effort in California, Oregon, maybe elsewhere, to do a single-payer system at the state level. That’s very unlikely to happen under a Trump administration. The kinds of flexibilities and, you know, system changes that a Trump administration would want tend toward the punitive, right? Like work requirements for Medicaid or tend[ing] toward junk insurance.…Project 2025 is notorious, right, as a kind of blueprint for what might happen.
“And they talk about competition, and that usually means more market-based healthcare, which has failed and hasn’t met people’s needs. Because if you let people just organize health care based upon profit, guess what? Profit wins and patient care suffers. …
“They would try to repeal the Affordable Care Act, presumably, I don’t think they could, because people are afraid of losing what they have given how bad the system is. But you have to figure that’s on the agenda.
“You have to figure abortion rights, and abortion access, would be severely restricted one way or the other. We don’t know exactly how, but we know it would happen. Contraception could be on the chopping block as well. IVF – In vitro fertilization. All aspects of reproductive health would be jeopardized under a Trump administration. We kind of have to start with that really.
“And then can’t be optimistic about Medicare…I wouldn’t say that the Democrats have a good record on preventing privatization of Medicare, but presumably [with a] Trump administration that would go on steroids. It could very well be that, especially if they control Congress, you could have a fully privatized Medicare within four years.” – Michael Lighty
Why is privatizing Medicare so concerning?
“…the public [version] of Medicare means you can go to any doctor and there aren’t preauthorizations. There’s no limited network. There are high out-of-pocket costs in some cases, which we need to solve. And there are some gaps in coverage, which are, you know, covered by private plans.
“But by and large, the promise of traditional Medicare is a guarantee that you’ll get the healthcare you need regardless of ability to pay. And over time, that has eroded to some extent. But that’s still the heart of the program … that financial incentives are not denying you care.
“… under a privatized system like Medicare Advantage, you have a limited set of providers … the plans compete to get the healthiest patients, and you end up in a situation where you can still have very high out-of-pocket costs. The coverage, like for dental, still isn’t great.
“And yet these private companies are making billions. You’ve got a situation … where the insurance company is diagnosing patients after the doctor’s primary diagnosis. They do what’s called upcoding so that they make the patient appear more severely ill than they actually are. More severely ill than their doctor said they are…so the insurance company is diagnosing patients and then getting reimbursed based upon the more severe diagnosis. I mean, they game the system in many ways.
“So a privatized Medicare [means] basically people over 65 are subject to arguably even worse abuses than those of us under 65 who have to deal with the commercial insurers. So there’s a lot at stake there.” – Michael Lighty
Contrast that with what we might expect from a Harris administration.
“The Affordable Care Act increased subsidies, which expire in 2025 … [they] would presumably be extended … You could imagine a much more robust regime of price negotiations for prescription drugs. You could imagine an ability to level the playing field for Medicare. You know, President Biden had committed to that before he dropped out of the race. I’m certain that president Harris would be inclined to do that as well.
“And also, what you’re already seeing in the Harris campaign is a commitment to the caring economy. So those things like home health and child care and support services would be very much at the top of the policy agenda in healthcare, a robust effort to protect reproductive rights and access to reproductive healthcare.
“You could absolutely see … an anti-discrimination agenda in healthcare, real effort around equity and addressing social determinants of health. All of that would be on the agenda and would be implemented based upon whether there’s democratic control of Congress or whether they have to achieve it through executive action.
“Mental health parity, I think is something that would be off the table under Trump, and very much, you know, on the table under a Harris administration, because really that mental health gap, it’s true in Medicare – we didn’t mention it, but it’s true in Medicare – and it’s true at all levels of the healthcare system, that people simply don’t get the mental health care that they need.” – Michael Lighty
Helpful Links
Election 2024: Compare the Candidates on Health Care Policy, KFF
Hundreds of proposals in Project 2025 match Trump’s policies, CBS News
Project 2025 Blueprint Also Includes Draconian Cuts to Medicaid, Georgetown University, McCourt School of Public Policy, Center for Children & Families
Harris is Reframing Health as an Economic Issue, KFF
Harris vows Biden-era health care programs will get bigger if she’s elected, The Hill
Episode Transcript
Read the full episode transcript.
Biography: Michael Lighty
Michael Lighty, President, Healthy California Now, has organized, advocated and developed policy for single-payer, Medicare for All nationally and in California for over 30 years.
He is a founding Fellow of the Sanders Institute, and most recently, he was the Healthcare Constituency Director for Bernie 2020.
Formerly he was director of public policy for the California Nurses Association/ National Nurses United. He was lead policy analyst, a leader of Campaign for a Healthy California and testified on behalf of the single-payer bill, SB 562.
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