The first debates between the two candidates just passed with much fanfare. Lots of yelling and screaming. But what does it really mean in a practical sense? Since radiology residents have a long career ahead of them, I started thinking about how each candidate’s policies will affect the financial status of radiology practices over the short and long term, if enacted. In a real sense, these policies are likely going to be altered due to the congressional makeup. If Hillary Clinton gets elected, it is likely that anything she tries to pass through congress will be blocked by a republican congress. On the other hand, Donald Trump is likely going to have difficulty pushing through his agenda with all of the political interests out there. Even so, I went to their websites: Hillary Clinton and Donald Trump. I then extracted the most salient health care policies and imagined what they would do to radiology if they had full control of their health care policy without the interference of Congress. So, here is a list of some of their most important health care policies. I will evaluate which policy would be more helpful over the short and long term for each candidate and assign a point to the winner of each. Whoever has the most points wins! Let’s get started…
Hillary’s position: “Defend and expand the Affordable Care Act, which covers 20 million people.”
So, let’s say Hillary expands the Affordable Care Act to cover the additional uninsured. Well, that’s great, radiologists are going to get a slight bump up in revenue due to newly insured patients entering the market. Not so fast though. Where is the money coming from to pay for all of this? Hmmm…. There’s only two places: increasing taxes or debt!!! So, net-net over the short term it’s probably a wash or a slight positive.
What about the long term for Hillary’s policy? Well, if you consider a limited pool of funds for all health care and the hatred of the American public toward rising funds for the delivery of health care year after year, the pool of money dedicated to radiology is going to shrink over time. So, I would say long term the net effect on radiology is pretty negative.
Trump’s position: “Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.”
Right now, there is an overall increase in insured patients that were formerly uninsured. These patients were added to the newly insured population with the new Obamacare laws. So temporarily, many radiology practices that are targeted to more underserved communities have experienced a bit of a bump in payments. If Obamacare is removed, those payments begin to go away. So, there is a net loss of revenue over the next few years if this policy is enacted.
Over the long term, the net amount of money available in the pool for Obamacare is fixed and doesn’t change unless taxes are raised or lowered. Over time, the radiologist’s pool of money within Obamacare would not significantly change or be slightly cut. And, the pool would be eroded by medical care inflation. So if you take away Obamacare, you will return to a fee for service state and allow for the reinflation of the radiology pool via the natural laws of supply and demand. Also, you will not need as much tax relative to the maintenance of Obamacare. Both of these factors provide a net long term positive for the radiologist.
Short Term Winner Based on These Policies: Hillary Clinton, 1 point
Long Term Winner Based on These Policies: Donald Trump, 1 point
Hillary’s position: “Bring down out of pocket costs like copays and deductibles”
In my experience, when you lower insurance deductibles, a practice is more likely to collect the fees charged. Patients tend not to be as responsible with payments as the insurance company. Therefore over the short term, you increase a radiology practice’s revenue. Nice, huh?
Well, wait a moment… Again, how would the United States bring down the out of pocket costs of the copay or deductible? There are only two ways! Increase taxes or increased debt. Either way, taxpayers pay in the long run. The other question that we need to think about as well: Is this policy sustainable with the rising costs of health care? I’m not so sure.
Trump’s position: No counter position on same policy.
So, we have to assume the status quo in terms of deductibles and copayments. In the short term, practices will received less funds because deductibles and copayments are allowed to remain high. In turn, practices will receive less payments due to increased patient responsibility.
But, taxes will not have to be raised to cover these expenses. Relative to the Hillary plan, over the long term it is probably better financially for a radiologist.
Short Term Winner Based on These Policies: Hillary Clinton, 1 point
Long Term Winner Based on These Policies: Donald Trump, 1 point
Hillary’s position: “Fight for health insurance for the lowest income Americans in every state by incentivizing states to expand Medicaid”
Similar to her position of defending the affordable health care act, getting more people insured will allow radiologists to collect more payments, especially in lower wage communities. This will allow a temporary bump in radiology revenue until the pool of money slowly declines due to inadequate government funding and the erosive properties of inflation. A net positive for the short term and negative for the long term.
Trump’s position: “Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.” and “Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.”
What happens when you fully deduct your business health policy? It allows you to purchase more health care insurance. So, you get more bang for your buck. And subsequently, you may decide to go for that cardiac calcium scoring study that you wouldn’t have had otherwise since you have a higher end policy and your insurance pays for it. Over the long and shorter term, it is better for radiologists’ wallets than health insurance for all. You drive more higher end studies into the system that reimburse better. This policy would have a clear lasting short and long term positive effect on radiologist’s pay.
Allowing Medicaid grants to all states, on the other hand, does not allow such a clear forecast. Some states already have a lot of money dedicated to Medicaid and other’s don’t. So the answer to the benefits for Medicaid block grants long and short term is: It depends. However, since most practices are not primary Medicaid practices, the Trump’s deduction policy from business income holds more weight. So therefore:
Short Term Winner Based on These Policies: Donald Trump, 1 point
Long Term Winner Based on These Policies: Donald Trump, 1 point
Hillary’s position: “Double funding for community health centers, and support the healthcare workforce: As part of her comprehensive health care agenda, Hillary is committed to doubling the funding for primary-care services at community health centers over the next decade. Hillary also supports President Obama’s call for a near tripling of the size of the National Health Service Corps.”
Sounds nice in principle. But when government gets involved with business of any sort, including health care, it tends to involve a lot of wasted resources. Think of thousand dollar toilet seats that need to be bought from a particular manufacturer due to governmental contractual obligations. My questions for Hillary would be: What are the particular services and health care centers for which you are actually doubling funding? Is triple the national health care service corps actually going to reduce the price of health care? In either case, I’m not so sure the resources would be used correctly. Our taxes will go up to pay for these obligations. Net-net short and long term, this would definitely be a negative
Trump’s position: “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.”
This is probably the most murky of the propositions. Much of what inflates radiology payments is the lack of transparency of the payments. Currently, most patients will go to an imaging center based on the referral pattern of a physician and not the relative payment schedules of an imaging center. If prices are posted by each practice in a comparable and easily accessible way, current referral patterns have the potential to change with subsequent price declines. Lack of transparency is a net negative for the patient and a net positive for the finances of a radiologist. When this pattern reverses, I think that Trump’s proposition would be a net short term and long term negative.
No Short Term or Long Term Winner Based on These Policies: Donald Trump, 0 points and Hillary, 0 points.
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So let’s sum it up. Short term winner is Hillary Clinton: 2 points. Long term winner is Donald Trump: 3 points. Therefore, if you are a radiologist recently coming out of residency and are thinking about the long term, it likely makes sense to vote for Trump. If you are about to retire and want shorter term benefits- maybe Hillary is your gal (that’s of course if radiology finances/income are all you worry about! Hopefully that’s not the case!!) So that’s it… Hope you enjoyed the analysis!!! Would love to hear your comments…
