With the nation sharply focusing on the November 8 presidential election, the choice between Republican candidate Donald J. Trump and Democratic candidate Hillary Clinton has been all about personalities, not about policy differences. Facts have taken a back seat to flamboyance.

To many, the election choice seems to be between an ethically-challenged, calculating lawyer/politician versus a drunk-uncle-style egomaniac. No surprise then, that both Trump and Clinton have unfavorable ratings above 50 percent in most polls, leaving many voters to hold their nose and choose – in their words – between a crook versus a crazy.

Fair descriptions or not, these are the Democratic and Republican presidential nominees. The actual choice facing voters are two candidates with sharply different views of the world. Where they have articulated a clear policy, like on issues involving immigration, ISIS and the economy, the differences are often stark. But little has been spoken about key issues with special importance to seniors.

So let’s take a look at issues like Social Security (SS), Medicare, Alzheimer’s disease, drug prices and Obamacare, and look at where the candidates have taken positions on the campaign trail. Hillary Clinton has spelled out detailed position statements on her website and in speeches, while Donald Trump has articulated more generalized positions, largely devoid of detail. Third-party candidates Jill Stein of the Green Party and Gary Johnson of the Libertarian Party have also taken strong positions on key seniors’ issues. 

Social Security and Medicare

Social Security and Medicare combined account for roughly 40 percent of all federal spending. As things stand now, unless SS is fixed to secure its financing, benefits will be cut by 21 percent starting in 2034.  Medicare, the federal program that pays elderly Americans’ hospital bills, will start to run out of money in 2028, causing a reduction in benefits if it’s not fixed.  Realistically, the only ways to shore up the SS system are by raising taxes, cutting benefits (which could include raising the retirement age) or both.

But Medicare is in better shape than it was last year, according to the most recent trustees report, because changes put in place under the Affordable Care Act have extended the program’s insolvency date by 11 years. Medicare’s trust fund pays only for hospital services under Part A, while the rest of Medicare spending on doctors, drugs and outpatient care are paid for primarily with general fund revenue.

Hillary Clinton has articulated a detailed plan to fix the problems facing SS for the long term. She would require asking higher-income Americans to pay more in taxes above the current cap ($118,000) and taxing some of their income not currently taken into account by the SS system. She is asking higher-income Americans (people earning more than $250,000) to pay more, so that SS is not subject to the budget whims of Congress or the fluctuations of the stock market.

Clinton has vowed to continue to fight Republican efforts to privatize SS. She told AARP recently that she would “fight any attempts to gamble seniors’ retirement security on the stock market through privatization,” which House Speaker Paul Ryan, R-Wis., and House Republicans have repeatedly pushed for, in many different forms over the past few years. 

But Clinton wants to push even further, by expanding SS for those who need it most — including widows and caregivers who took time out of the paid workforce to take care of their children, aging parents or ailing family members. The poverty rate for widowed women 65 or older is nearly 90 percent higher than for other seniors, in part because when a spouse dies, families can face a steep benefit cut – for a two-earner couple, those benefit cuts can be as much as 50 percent. Clinton proposes to change that so spouses don’t suffer financial hardship as a result of the loss of a spouse.

For caregivers, SS benefits at retirement are often cut because those benefits are calculated based on their top 35 years of earnings. Clinton proposes giving them credit toward their SS benefits when they are out of the paid workforce because they are working as caregivers. She would pay for this with the tax increases to wealthier people. She strongly opposes reducing annual cost-of-living adjustments, disagreeing with the Democratic convention platform, which favors increasing them compared to the way COLAs are calculated today.

Clinton’s position starts with her long-standing opposition to privatization or to the phasing out of Medicare. She also strongly opposes any attempt to weaken or repeal the Affordable Care Act, which she says has made preventive care available and affordable for the 55 million Medicare recipients and saved more than 9 million seniors with thousands of dollars in prescription drug expenses.

After some pressure from her primary opponent Sen. Bernie Sanders, D-Vt., who advocated a single-payer health care system, Clinton took a step toward that position, proposing in May that people as young age 55 be able to voluntarily pay to join Medicare. That could help the 7 million people age 50 and over who are still uninsured (as of 2014), according to an analysis by Avalere, a DC-based consulting form. She calls her proposal “Medicare for more.”

Donald Trump’s website does not mention SS or Medicare at all. He has rarely made a public comment about it in 14 months since launching his campaign for president. Contrasting with his Republican colleagues, Trump has promised not to cut SS and Medicare. He has said that anybody who promises to severely change them will “lose the election,” and as Trump says often, he does not like to lose. But as far as details, there aren’t any, so far.

On the campaign trail, he has said he would generate more SS payroll taxes by bringing back jobs and by getting rid of “deficits, waste, fraud and abuse,” which he said is rampant. That coupled with his proposals of cutting taxes for the middle class, he says will help fix the problem.

Trump's chief policy adviser Sam Clovis has suggested that Trump would, in fact, be open to curbing entitlements if his $10 trillion in proposed tax cuts didn't spur enough growth to create a budget surplus. Last May, Clovis said: “After the administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like SS and Medicare,” he said, according to the Wall Street Journal.

Trump is against raising payroll taxes in general and opposes raising the SS payroll tax cap of $118,500 on earnings subject to FICA taxes. He has just taken a position on helping family caregivers (details not yet available) and has not talked about privatizing SS where workers could manage their own retirement funds through personal investment accounts.

Trump has said he opposes raising the SS retirement age, which is now between 66 and 67, depending on what year you were born. “It’s my intention to leave SS the way it is,” Trump has said. That puts him on the opposite side of his Republican colleagues, as Ryan and House Republicans want to raise the retirement age to 69 or 70. Trump also opposes changing the way cost of living adjustments (COLAs) are calculated. Many other Republicans want to make these annual increases less generous than under the current formula.

But again, Trump has not yet provided any details. His few campaign statements on Medicare, like SS, put him in direct conflict with Congressional Republicans who have strongly advocated for a “premium support model” for Medicare that would guarantee every recipient an income-adjusted contribution toward a plan of their choice with catastrophic protection. That translates to some form of privatization. Republicans, the platform says would “save Medicare by modernizing it.”

Alzheimer’s

On Alzheimer’s, again Trump has only spelled out a general position, where Clinton has a detailed plan. But he definitely has some knowledge about how difficult Alzheimer’s can be on a family. His father, Fred Trump, suffered from Alzheimer’s for six years before he died in 1999.

Trump called Alzheimer’s funding a “total top priority for me. I have so many friends whose family is devastated by Alzheimer’s. So, it’s — believe me, it’s a total priority. That’s something that we should be working on and we can get an answer.”

Nearly one in every five Medicare dollars right now is spent on people with Alzheimer’s and other dementias. But by 2050, that will be one in every three dollars and it is projected to cost more than $1 trillion, with costs to Medicare increasing by 360 percent.

Clinton has laid out a detailed plan to dramatically increase federal research efforts to help find a cure. In effect, Alzheimer’s funding is her “moonshot” proposal. To find an effective treatment, she is pushing to invest $20 billion over the next decade – $2 billion a year –which is far higher than the $936 million appropriated this year and the $1.4 billion approved for next year.

She also is pushing initiatives to help caregivers, including favoring a new tax break for individuals caring for aging parents or grandparents. Her plan would let a family caregiver deduct 20 percent of caregiving expenses, up to a total of $6,000. That would result in a total tax savings of up to $1,200. About 34 million Americans provided unpaid care to an adult 50 or older in 2014, according to a 2015 report by the National Alliance for Caregiving and AARP.

Affordable Care Act

Where the two candidates disagree most on healthcare related subjects is over the future of the Affordable Care Act, better known as Obamacare.

Trump has vowed to kill Obamacare “on day 1” of his administration. Specifically, he wants to change current law to allow the sale of health insurance across state lines, which many states oppose because they would lose the ability to regulate insurance companies outside their state borders. Trump says the increased competition would allow health care costs to do down. He blames illegal aliens for the high cost of health care, arguing “If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.” Trump also wants to change the tax code to allow individuals to “fully deduct” health insurance premiums from their taxes.

Clinton wants to build on the Affordable Care Act and make it stronger, by working with the governors of 19 states that have refused to expand Medicaid in their states to offer Obamacare. She has articulated a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored "public option" as an alternative to private insurers.

She wants to require insurers and employers to provide up to three sick visits to a doctor per year without needing to meet the Obamacare plan’s deductible first. She is pushing for a refundable tax credit of up to $5,000 per family for excessive out-of-pocket (health care) costs, in particular to help middle class families who currently don’t benefit from current medical expense tax deductions.

Clinton and Trump both agree on changing the law to allow Medicare to negotiate prescription drug prices. That approach was specifically banned when the GOP Congress added the Part D drug benefit to Medicare in 2003.

Both Trump and Clinton have also called for changing U.S. law to allow the importation of drugs from foreign countries to save Americans money. This has been proposed repeatedly over the years in Congress, but has never been enacted into law because of strong pressure from the pharmaceutical industry which has always raised questions about possible contamination and safety concerns about drugs coming from outside the country without Food and Drug Administration scrutiny.

Third-Party candidates: Jill Stein/Gary Johnson       

Jill Stein of the Green Party opposes privatizing of Social Security and favors raising the cap on SS to help fix the system’s long-term finances.  During her campaign she has argued against Obamacare and in favor of a single payer health care system like Democratic Sen. Bernie Sanders supported.  She also argues in favor of changing Obamacare to a broader Medicare-for-all system.

Libertarian candidate Gary Johnson favors saving Medicare but argues he would like the federal government to let the state governments run Medicare and Medicaid, allowing the state to be a laboratory for finding innovative ideas for Medicare and Medicaid. Johnson favors repealing Obamacare and also wants to eliminate Medicare Part D, which he calls “the failed Medicare prescription drug benefit.”

Johnson has, in the past, called SS, “a Ponzi scheme.” To fix it going forward, Johnson suggests a combination of benefit reductions and or privatization. He favors including private accounts that people can invest in and control themselves and also supports raising the retirement age and means testing for future retirees to put the system on better long-term financial footing.

While the outcome of the election is anyone’s guess, one thing is already clear from the way the nation appears bitterly divided. Whoever wins will struggle to unite the disaffected voters of the loser’s side. That means that neither a President Trump nor a President Clinton will get much of a bipartisan honeymoon to get much done next January.

[Also contributing:  AP; AARP; Twin Cities Public Television; Financial Times; Kiplinger, Slate.com; Statnews.com; Ontheissues.org.]

Alan Schlein runs DeadlineOnline.com, an internet training and consulting firm. He is the author of the bestselling “Find It Online” books.

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