Trumping Obamacare

When it comes to healthcare Donald Trump has a two-part plan, repeal Obamacare and replace it with something better.  As with other proposals by the president elect, specifics remain scarce.  Upon meeting President Obama and later Jonathan Gruber, the MIT professor regarded as the architect of The Affordable Care Act (Obamacare), Donald Trump came to the same realization most Americans do when the law is broken down, he actually liked it.

Reduced to individual components, president Obama’s signature legislation is extremely favorable.  Most, if not all, individuals agree health insurers ought not deny coverage based on preexisting conditions or a costly illness, no limits on lifetime dollar maximums, allowing dependents up to twenty-six years of age to remain on a policy and guaranteeing coverage standards including preventative care.  A common sticking point for detractors remains the individual mandate, the idea that everyone must purchase coverage or face a penalty.

Donald Trump has echoed such criticism, adding the challenge of cost containment.  First, Obamacare was never intended to reduce healthcare costs, at least not directly.  Second, the individual mandate, a concept pushed by The Heritage Foundation, a conservative think tank, is imperative in maintaining aforementioned elements everyone, including Donald Trump, love about the law.

The individual mandate is essential to the viability of Obamacare.  To reference real estate terminology, maintaining popular provisions while eliminating unfavorable ones, will likely create a foundational shift precipitating a complete collapse.  Without the mandate and requisite penalty, individuals may delay purchasing coverage, taking full advantage of the pre-existing condition clause, acquiring insurance at the eleventh-hour.

Obamacare is by no means a panacea for the complicated, public, private, three trillion-dollar U.S healthcare industry.  Much good has come from the law including Medicaid expansion, a navigable insurance marketplace, vouchers and tax credits leading to 15 million more insured individuals.  Costs for medical care and health insurance have not decreased, however.  They are merely increasing at a slower rate when compared to previous years.

Before Barak Obama became president, Americans paid more for the same drugs, services and procedures when compared to other industrialized countries.  Simply stated, healthcare in America is expensive and the government has done little or nothing to cut costs.  George W. Bush signed a Medicare drug expansion and failed to add a provision allowing negotiating drug prices as nearly all countries do.  Drugs in Canada or Europe cost a third to a quarter for the same prescription, Obamacare has also done little to address such a discrepancy.

Providing access to coverage was and remains the objective of The Affordable Care Act, and by that metric, it has been successful.  Insuring more people, including healthier, younger individuals the theory goes, will decrease costs.  Clinics and hospitals often inflate baseline prices, charging exorbitant fees for a Band-Aid or an aspirin to mitigate losses of treating the uninsured.

Patients remain relatively unaware when it comes to fees or coverage for a standard outpatient visit or extensive hospital stay.  Price transparency, an elusive provision of Obamacare, is vital in addressing rising rates.  The Affordable Care Act is relatively new and many provisions, including price transparency, have not been given adequate time to mature.

At some point, a politician must take the unenviable position of challenging powerful interests, with ever increasing lobbying power.  Medicare, which insures 54 million Americans, remains at the mercy of big pharma when it comes to pricing.  Compelling health insurers, beneficiaries of government vouchers, credits and incentives, to create affordable, income based plans, also remains elusive.

Negotiation, as Donald Trump regularly proselytizes, may be the missing component to healthcare reform.  Negotiating with big pharma regarding drug prices, negotiating premiums with insurance companies and negotiating prices for common medical procedures.  Medical expenses are the leading cause for personal bankruptcy amongst Americans.  Through negotiation, Mr. Trump may seize on the affordability which has eluded his predecessors, ensuring folks avoid bankruptcy, when it comes to their health at least.

Dr. Bashar Salame is an award winning author and healthcare provider in private practice for fifteen years. Read other articles by Bashar.