Will Donald Trump Make Good on His Promise to Fix Obamacare?

On the campaign trail and in the debates, presidential candidate Donald Trump promised to fix Obamacare. No – he actually vowed to dismantle Obamacare. He never did quite get around to articulating exactly what he would replace it with. But now that he has been elected president, we can only hope that he will make good on his promise to revamp the health care system once again.

The Problems With Obamacare

I’ve noted several times on Out Of Your Rut that the basic flaw with Obamacare is that it did nothing in regard to cost containment. Not only have premiums risen steadily since the plan was implemented, but the out-of-pocket requirements have risen at least as fast.

CNN/Money reported last month that Obamacare premium rates are expected to rise by 22% in 2017, compared to an increase of “only” 7.2% in 2016. Equally significant, the article also reports that the number of participating insurance carriers will decline from 298 in 2016 to 228 in 2017. As a result, 21% of consumers will have a choice of only one carrier in their state.

Will Donald Trump Make Good on His Promise to Fix Obamacare?
Will Donald Trump Make Good on His Promise to Fix Obamacare?

What we have now is a byzantine system of health insurance in which more people are eligible than ever, but one that they can’t easily afford. For this reason, many millions of people continue to go without health insurance coverage. It does little good to have all kinds of beneficial mandates if people still can’t afford to pay the premiums.

Don’t get me wrong, there are a few things that Obamacare did that represent major positives, and that eliminated decades of unfair treatment of consumers. At the top of the list are that you can no longer be denied coverage for health conditions, nor can you be charged higher premiums for those conditions. We can only hope that any revised healthcare plan that the Trump administration proposes will retain these provisions.

We Can’t Go Back to the Good Old Days of Healthcare Because they Weren’t that Good

There is a misguided belief in some quarters that we can simply overturn Obamacare and go back to the way things were. But that won’t fix anything.

A system that disqualifies people due to poor health is hardly an equitable system. And charging people outrageous premiums due to health has the same net effect. That is, if a person in poor health cannot afford sky high premiums, that is the equivalent of denying them coverage. You have to hope that as a nation we moved beyond that kind of thinking.

Many in the anti-Obamacare crowd are also fond of blaming high health insurance premiums on Obamacare itself. There’s no doubt that Obamacare has played a role in the continuing healthcare cost spiral. But at the same time we have to acknowledge that the cost of healthcare was already increasing faster than the general rate of inflation for decades before Obamacare was implemented.

That’s the basic problem with the entire US healthcare system. There are not – and have never been – any constructive limits on the rising cost of healthcare. For the most part, the public doesn’t seem to care about costs anyway. As long as someone else pays for health care – either the insurance companies or the government – people are largely insulated from the actual cost of care.

It’s a fact that the healthcare system in the US is proportionally more expensive than it is in other developed countries. We dedicate more than 18% of our gross domestic product to healthcare, while other rich countries average just 9%. And in many of those countries, people live longer on average than we do in America.

What is perhaps even worse is that our system is so unbalanced, despite the fact that we pay twice as much for healthcare as other countries. People who are on government health insurance plans, or goldplated private plans, have access to virtually unlimited healthcare. But at the same time, tens of millions of people have to make a choice between getting medical treatment and making their house payment.

Even if Obamacare is completely eliminated tomorrow, we will still be stuck with that high cost structure. Returning to the pre-Obamacare system won’t fix that, and in fact is far more likely to continue the same process of ever higher costs.

Trump Will Either be a Hero or a Villain

There’s no doubt about it, should Trump succeed in implementing a health care reform plan that satisfies at least most of the population, he may very well go down in history as one of the greatest of American presidents (though few in the mainstream media – with their fixed fascination with the Left – will ever willingly admit to it).

But it’s also entirely possible that a new health care plan will see him go down in history as a villain. Healthcare is a very sensitive issue, a very emotional one that people rarely discuss rationally. Any effort to reduce health care costs will lead to inevitable charges that Trump is trying to kill babies, starve children and throw Grandma out of her home – the standard arguments whenever there’s the threat of a program being cut or eliminated.

Due to the runaway costs of the current healthcare system, it is likely that any new plan will have to ration health care benefits in some way. That will be the only way to stop the healthcare cost spiral, and to make it actually affordable for the greatest number of people.

But rationing is not what people want to hear when it comes to healthcare. Most people prefer to play the “let’s pretend game”, as in let’s pretend that we actually can afford unlimited healthcare forever.

The reality is that we can’t. Any attempt to reform the current system is going to have to include a strong dose of cost-containment. That will mean rationing, even if some other term is used to describe it.

People are unlikely to react kindly to that, even if it is the only logical choice.

It’s far more likely that we will not get anything that looks like real healthcare reform until the current system undergoes a major crisis, as in something that looks like a wholesale collapse. That will happen when it reaches a point where John and Jane Q. Citizen can no longer afford to pay their health insurance premiums, nor the massive medical bills they will receive whether or not they even have coverage. And when that starts to happen, both insurance companies and healthcare providers will begin to disappear for lack of money.

At that point, it will be a full-blown crisis, and not only will the politicians be ready to react more rationally, but the citizenry may finally come to a point where they’re willing to accept compromises in coverage.

Not a happy story at all, but we’ll have to see how it all plays out.

What you think? Can Donald Trump make good on his promise to fix Obamacare? Or will it be yet another campaign promise that fades into obscurity now that the election is over?

( Photo by joshkehn )


6 Responses to Will Donald Trump Make Good on His Promise to Fix Obamacare?

  1. I think that because the Republican majority in Congress also want to redo Obamacare, something will be done. There are so many factors involved in the cost of health care but one thing you said is certainly true. Unlimited cheap (or free) healthcare could not last. I recall my late in0laws going to the doctor almost every week. Every time my FIL had a cough, off they went. Or each time they found a bruise on their 90 year old arm, the doctor got a visit. They used the doctor as a social outlet for which Medicare and insurance paid. There needs to be a way to penalize frivolous visits both to the doctor and the ER without jeopardizing the ability of the truly ill to receive care. Smarter people than me will have to figure that one out.

  2. Hi Kathy – One way to reduce frivolous doctor visits and tests would be to increase copayments for routine procedures. The elderly tend to go to the doctor a lot because between Medicare and a supplement, they never have to pay a bill. There’s no reason not to go.

    I personally think that copayments should be increased and deductibles lowered. What we really need health insurance for is major medical events, not running to the doctor because you have a cold, or because you sprained your ankle. On the other hand, it’s criminal that a person has cancer or a cardiac event and has to pay thousands out of pocket. Health insurance needs to be mainly for life-threatening or life degrading events, not routine stuff that’s likely to heal on its own. That’s the kind of rationing I hope we’ll see.

    We’re not likely to get a complete overhaul that will fix everything, but we have to hope for improvement, and especially to an end to the relentless cost spiral. If we can get that we’ll be heading in the right direction. Other issues can be fixed as we move forward. There’s a unique opportunity right now in that we have an allegedly reform president, with a congress dominated by his own party. He has two years to make it work, after which he’ll become a lame duck for the remainder of his term.

  3. Glad to see you bring this up. This election has brought a lot of emotions out of people, but this is an important part of the future for this country. Obamacare has taken its fair share of criticism, but it is one thing to talk, and another to do. Trump will have a tough choice ahead with his plan for healthcare and I truly hope that our newly elected president will make the right choice for this country.

  4. Hi David – Yeah, now that all the partisan political crap is over, it’s time to get on with the business of actually doing something to improve the quality of life in the country. As citizens, we need to hold Trump to his campaign promises. There are a lot of people struggling under the current healthcare set up and it’s time for real reform to a workable – though imperfect – system.

  5. As a Canadian looking in at the American system from the outside and at our own system from the inside the largest driving force that I see for the spiraling costs in both systems id the advancement of medical technology rather than the usual presumptive drivers. New treatments, procedures, drugs and medical appliances are generally added on top of ones already being done, not always replacing old ones.

    We demand the best of treatments available which often offer costly treatments for previously untreatable, or only marginally treatable conditions. At the same time, the medical system still binds wounds and set broken bones as it did when it began. new treatments have added to the range of practice and the cost of medicine since the days of Hypocrates.

    Both our systems control costs today by rationing: Canada by limiting public funding for the essentially single payer system and the US by the cost of premiums for insurance. Neither appears to work as well as the system in some European countries that feature a mix of universal public and private payment for medical services.

    The political challenge for both our countries is that neither of our electorates are open to even exploring the possible merits of a substantial shift to the middle.

  6. Hi Robert – Thanks for offering a perspective from outside the US. We need that more than we ever admit. I have to agree on the increases in medical technology is being a major part of the cost issue, but it’s certainly not the only driver. Too many promises have been made, and at least here in the US, there’s too much defensive medicine – ordering tests and procedures out of fear of litigation. That’s true to some degree in all countries, but much more so in the US. We’ve also turned healthcare into a gravy train where people demand the best and the most. And naturally there’s also the political driver, of “let ’em eat cake”, a.k.a., we won’t tell them any bad news. But rationing is probably the only way out. There are BMWs out there, but if you can only afford a Chevy, then a Chevy is what you get.

    We probably need a blended healthcare system, similar to Europe, or what we in the US do with Medicare, plus a Medicare supplement. I read that in Italy, they have a public system that covers about 75% of costs, but then you can get a private supplement to cover the balance. That’s probably what we’ll have to do here, but the Left wants universal coverage, and the Right wants a private solution. In the meantime, we’ve got this wonky hybrid that seems to be serving no one particularly well.

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