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.
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?