In this first of a multi-part series, we look at what each of the main presidential candidates is proposing and how those proposals will affect healthcare and your personal finances.
With the New Hampshire primaries now in the rear-view mirror, the Republican field has basically narrowed to a handful of candidates, led by Donald Trump and Ted Cruz. It will take more primaries to further reduce the field. On the other side, New Hampshire effectively doubled the field of Democratic candidates: from one (Hillary Clinton) to two. Vermont Senator Bernie Sanders’ decisive win in New Hampshire was a final confirmation that the nomination is no longer the shoo-in for Clinton that many expected it to be earlier this summer. It’s a dogfight now.
President Obama, obviously had a significant impact on healthcare providers through the passage of the Affordable Care Act and increased taxes for high earners. In a series over the next few weeks, we’ll look at what physicians can expect—in terms of changes to healthcare and personal finance issues—if each of the surviving candidates is elected. We’ll start with the Democrats, and with the steady emergence of Bernie Sanders into a legitimate contender.
Is it possible to be an anti-establishment candidate when you’ve been part of the establishment for more than two decades? In the case of Vermont Senator Bernie Sanders, the answer is yes. His first term as a Congressman was as an independent, and as a politician, he has sacrificed friends and allies throughout his career by being critical of politicians on both sides of the aisle. In a political environment in which the word “socialist” is a label to avoid, Sanders embraces it, and his non-nonsense campaigning style and unapologetic views on economics have resonated with younger voters in particular, but not yet with minority groups that propelled President Obama to victory over the last two elections.
Sanders on Healthcare
Sanders voted for the Affordable Care Act, considering it an improvement over the old system, but stating loudly and often that it did not go far enough in improving access and care for all citizens. Sanders is on record that “Obamacare” was a “small victory” for the uninsured, and a big part of his campaign is based on the idea of creating a “Medicare for all” — a single-payer system for every American. “The United States must join the rest of the industrialized world and recognize that healthcare is a right of all, and not a privilege. Despite the fact that more than 40 million Americans have no health insurance, we spend almost twice as much per capita on healthcare as any other nation,” Sanders wrote in his Agenda for America. Under his system, healthcare would be publicly funded but privately delivered.
Where would that public funding come from? Mostly higher taxes for those in higher tax brackets. His draft plan includes a new healthcare income tax, an employer payroll tax, a surcharge on high-income individuals, and a tax on securities transactions. Sanders is counting on universal healthcare to control health costs, an area of disagreement with many on the other side of the aisle.
On abortion, Sanders is strongly pro-choice. “The decision about abortion must remain a decision for the woman and her doctor to make, not the government.” While Planned Parenthood has been in the GOP crosshairs, Sanders vows to expand funding for the organization. Sanders has strong positions on expanding mental health services to all, expanding Medicaid coverage, and curbing prescription drug prices through controls on generic pricing and drug reimportation. Sanders is also a big supporter of community health centers, which provide affordable primary care and mental health counseling.
Finance and Taxation
Last month, Sanders shared his tax plan, which includes a top tax rate on individual income of a staggering 52%—which would represent the largest tax rate since the Administration of Jimmy Carter. That rate would be reserved for those earning in excess of $10 million, but the hikes include significant pain for those in tax brackets specialist physicians typically find themselves in. For investors, Sanders’ plans include eliminating the preferential treatment long afforded capital gains and dividends; those income sources would be taxed at the same rates as ordinary income for taxpayers earning in excess of $250,000 per year. This could impact physicians who are part owners of a practice or who have significant investment income.
Sanders has vowed to target financial giants that he considers unjust benefactors of public largesse. “Wall Street cannot continue to be an island unto itself, gambling trillions in risky financial decisions while expecting the public to bail it out,” Sanders notes on his site and repeatedly in stump speeches. His view is that “too big to fail” equates to “too big to exist.”
Image by Phil Roeder (cropped)/Creative Commons License.