Healthcare has been one of the defining issues of both the current and previous presidential administration — if not the last dozen. When President Obama signed the Affordable Care Act into law, he signed over the nation’s economy and health to both the IRS and the big insurance companies. What was billed as a beneficial program aimed at increasing coverage for millions of Americans (which, to be fair, it did to a certain extent) became a significant financial burden on millions more, as well as having a chilling effect on small and mid-sized business growth.
But while the ACA was a massive gift to big insurance at the expense of the working class, the proposals by the Trump administration have been several magnitudes worse. Leaving the worst parts intact like the mandates and even increasing some of the costly subsidies that have made it a boondoggle, while at the same time repealing the parts that are popular, like assistance to the poor and the Medicaid expansion, the American Health Care Act would have been disastrous.
Other proposals have been given, such as clean repeal and varying degrees of replacement, but at the moment all bills are dead. Three GOP senators — Lisa Murkowski of Alaska, Susan Collins of Maine and, in a last-minute shocking swerve, Arizona’s John McCain joined their Democratic brethren to stop the AHCA. For now, the ACA lives.
Ironically, the estimates for the number of people who supported Trump and rely on the ACA are higher than those who opposed him. They voted for him knowing that one of his primary campaign promises was to strip them of their coverage. But others still oppose any form of government healthcare program, citing onerous burdens placed on employers and the poor in having to pay for it.
Among the libertarian-minded, a full repeal and a massive overhaul and reduction in insurance regulation would open up the free market to new options. They believe that the free market would necessarily reduce costs, as it has done in many other insurance markets, such as life, auto, and numerous others. But deregulation carries significant risk when playing with people’s health: Notorious supervillain Martin Shkreli is exhibit A as his near monopoly on certain drugs allowed him to take advantage of terminally ill who were forced to pay his prices or die.
Of course, the pharmaceutical industry is one example that can be cited the other direction as well. While drug prices are much higher in the United States than just about anywhere else for the customer, thanks to subsidies and regulation elsewhere, it’s this profit motivation that makes it worthwhile to even pursue these drugs. As pharma companies become vilified and profits begin to shrink for potentially life-saving drugs, many begin turning to more profitable lower regulation ones that can be priced as they choose without fear of backlash from consumers or the government.
On the flip side of all of this is the socialist-leaning and progressive contingent, anything short of a move toward fully socialized and/or single-payer care is a nonstarter. They cite European and Canadian models where coverage is universal — anybody and everybody can receive care regardless of circumstance or ability to pay. There are certainly major drawbacks to this as well — quality and timeliness of care are major concerns, as is the loss of control over many healthcare decisions — the court-mandated killing of Charlie Gard over his parents’ objections is a prime example of those fears borne out. Additionally, the costs to the consumer are still there, they are just more well hidden in the form of taxes. Still, most studies show that a move toward this model in the United States would costs substantially lower on the whole than our total costs now when taking into account that it would replace Medicare, Medicaid, the VA hospital system, and the entire health insurance industry. But the healthcare industry currently makes up more than a sixth of the economy, and the repercussions to the job market could be extreme.
The reality is that this issue will not see a resolution for some time in the United States. Offering more and more government-funded and mandated healthcare will certainly offer more coverage to the poor and those who are unable to get insurance otherwise, but at a major economic cost — not to mention a necessary drop in the quality of care and the possibility of violating fundamental civil liberties. But few would argue that the terminally ill who are unable to pay should simple be left to die and rot in the streets. For the time being, the ACA is still the law of the land, and adapting to it, while difficult, seems to be the only option.