Which candidate’s plan will actually make America healthy again?

With the presidential election less than a week away, health care is not on the ballot, but the winner will definitely impact the direction our health care system takes. In fact, the candidates’ respective approaches to health care appear to be diametrically opposed based on their previous statements and records.

A President Kamala Harris would likely extend coverage to millions more people by expanding the Affordable Care Act and the Medicaid expansion to all 50 states. She would also extend coverage protections to vulnerable populations that started during the pandemic followed by the Inflation Reduction Act.

A Harris administration would extend price negotiations for prescription drugs under Medicare while limiting out-of-pocket drug expenses to $2,000 per person per year. She has promised to promote legislation that would limit out-of-pocket insulin costs to $35 a month across the board.

Of course, all these measures cost money, and America already spends over $4 trillion a year on health care. And health coverage doesn’t always translate into actual care.

A second Trump Administration, in contrast, would focus on extending competition and free market solutions. He would try to increase price transparency, which would favor competition.

He has made statements that he would reduce Medicaid spending, which is currently costing more than $600 billion yearly, while preserving Medicare and Social Security. A second Trump administration would also likely focus on innovation and personalized health care solutions, expanding people’s investment in their own health, likely including more health savings account options.

Probably the greatest change would be Trump’s Make America Healthy Again initiative, spearheaded by Robert F. Kennedy Jr., which would focus on pre-disease prevention by battling the obesity epidemic, promoting a healthier diet, more exercise, and declaring war on ultra-processed foods.

With more than 40 percent of Americans now obese (up from 12 percent in the 1990s) as a result of empty calories and chemicals, there is an enormous burden placed on our health care system in terms of the chronic diseases that directly result, from high blood pressure to diabetes to heart disease and stroke, cancer, sleep apnea, back pain and falls.

We spend more on health care than any other industrialized nation, and in many areas, we have less to show for it, including shorter lifespans. At a time when new expensive personalized high-tech diagnostics and treatments are emerging, we are already overwhelmed with the costs of existing tests and treatments.

What is the solution? Whether you agree with Harris’s expanded one-size-fits-all coverage or Trump’s highly personalized high-tech, market-based solutions, one thing is certain: We are going to break the health care bank unless we reach people before they get sick.

That’s why I favor Make America Healthy Again and feel it should be bipartisan rather than just a campaign platform for Trump and the Republicans. Insurance companies might not like that premiums would be lower if people live longer, healthier lives, but it would certainly be better for our economy if they did so.

We must find a way to limit ultra-processed foods, eat more fruit, vegetables and fiber and sleep and exercise more.

Government subsidies will be well spent putting healthier foods back in the classrooms and the workplace. I have always said that gym memberships should include tax rebates.

Plus, a preventive medicine like Lipitor to lower cholesterol or Ozempic to treat weight gain and diabetes is far cheaper in the long run than a cardiac stent or gastric bypass surgery.

Making America healthy again needs to take place before you ever get to the doctor’s office in the first place.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of “COVID; The Politics of Fear and the Power of Science.”