Versión Español
EspañolIt is well known that one of the main campaign promises of US President-elect Donald Trump is the repeal of the Federal Patient Protection and Affordable Care Act, better known as Obamacare.
Trump promised to find a way to derogate this law, so that the prices of health insurance premiums may decrease again. The problem is that when there is a law as reformative as Obamacare, pragmatism must prevail over idealism.
I am aware and agree that this law has caused a great deal of damage to the working middle class and to small business entrepreneurs. However, if certain provisions of this law are eliminated too fast, there will be negative consequences in the short term.
The reality is that though many insurers have asked that the law be repealed, others depend on it. The immediate derogation of the law could have a negative effect that would cause insurers to lose thousands of clients, and hospitals would be filled with patients without any health insurance coverage.
This would create an economic crisis, as the loss of money from these insurance companies would lead to layoffs, and a humanitarian crisis for uninsured citizens.
Trump said after his election victory that he is planning to keep two provisions of this law: the one that prevents companies from denying health insurance to their employees with pre-existing conditions, and the provision that allows young adults to keep their parents’ medical plans until the age of 26. Democrats have already started to say that it is impossible to replace it and keep those two provisions.
Except that it is possible to repeal Obamacare and keep those two provisions at the same time.
What has failed with Obamacare has been the provision of an individual mandate, through which the government forces citizens to pay health insurance in exchange for not paying a tax as a fine. This is what causes health insurance premiums prices to be so high.
Though Democrats claim it has been a success, that is not true. The administration of President Obama expected that more than 21 million people would accept the mandate this year. However, only 12 million did.
This means that nine million people did not comply with the mandate of the law, which undoubtedly means that it failed. And why did it fail? Because those nine million people cannot afford health insurance, given that its premium prices are excessively elevated thanks to the very same provision that forces citizens to pay for one.
The US Congressional Budget Office determined that 71 percent of the people who are not covered cannot afford a health insurance premium. Trump makes it clear he believes in universal coverage, because he thinks that everyone with pre-existing conditions must be covered. What changes in his philosophy, in contrast to President Obama’s, is how to get everyone covered.
According to Obama’s philosophy, forcing people to get insurance is the way to achieve universal coverage, whereas Trump believes that jobs can guarantee that coverage. A transformation in healthcare is possible if Obamacare is replaced with a system that allows citizens to decide what type of premium they want.
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The problem of high health costs comes from laws and regulations that do not even have to do with insurance companies.
One of these regulations, for example, does not allow physicians educated and trained abroad to practice medicine in the US without complying with a series of requirements that take a lot of time and money. This long-term regulation has been key for the shortage of doctors in the US — by 2020, there will be 90,000 fewer physicians.
This shortage has contributed to an increase in the waiting time for a specialist as well as an increase in the price of treatments, since the demand continues to increase, but with less supply.
This regulation has put the US behind in medical advances, as many of doctors educated abroad come from countries with greater medical progress. This includes the FDA.
The FDA has also made healthcare more expensive, because any medical treatment or medication must be approved by them. The FDA operates according to lobbyists’ interests, and bureaucracy makes the approval process for an innovative treatment take years to pass, if approved at all.
There is no doubt that the challenge President-elect Trump will have to face goes far beyond Obamacare. And yes, I do think we have to repeal it, but everything must be done step by step.
If we really want health to be more accessible, we must look beyond insurance companies. The problem lies with the government, not with the private sector.
