Obamacare vs Trumpcare

We, as a nation despite our political leanings, are all still reeling from the end of the 2016 US presidential election. This may continue for months as we sieve through what it means to shift from a Barack Obama presidency to a Donald Trump presidency.

One of the most contentious, but signature, pieces of President Obama’s tenure in office was the Affordable Care Act. Many know it simply as Obamacare. It’s not perfect and has been derided on both sides of the aisle for either not going far enough or being an example of governmental overreach. But these are gut feelings and sound byte opinions. They are not the facts.

While some people in the US have seen their rates go up and have lost partial autonomy in choosing their tending healthcare physicians, it has boosted around 30 million into the realm of health coverage. A key component embedded in Obamacare is that preexisting conditions are no longer a barrier to getting a basic health insurance policy. This means that insurance companies can’t arbitrarily inflate premiums on policy holders because of their medical conditions. This is a tenet of most, if not all, Western Democratic countries. So, when the United States espouses democratic ideals throughout the world, this is a shining example of those democratic principles. But the US might be losing this bargaining chip.

President-elect Donald Trump vowed on the campaign trial to repeal and replace Obamacare. The standard bearers of the GOP, however, seem to be myopically focused on changing the Affordable Care Act.  As more and more people are covered under Obamacare, that otherwise wouldn’t have been, it becomes increasingly more difficult to chuck it out and start over. In recent days Trump and his transition team have stepped back from the notion of repeal. They now are discussing how to revamp and tweak the existing healthcare law. The question has yet to be answer as to what it will be replaced with or how the repeal will be implemented. Or more prosaically,  how will the executive branch and the legislative branch of government come to an agreement?

Generally speaking, healthcare has two ideological paths when it is being considered for legislation: either preventative care or acute care. In other words, do we choose as a nation to chip in an pay up front to reduce disease processes, or do we pay on the back end as the disease processes become urgent care? Regardless of the ideological choice, we will have to pay. It is almost ludicrous to think we would deny periodical healthcare to seniors, who are benefiting from Medicare, but accept them into ER’s around the country when their illness becomes severe.

Yet, this is essentially a real possibility if Obamacare is repealed and replaced with insurance company driven healthcare options. Take for instance, how mental health is handled in the US. Often those receiving care can’t afford the medicine or can’t afford to continue clinical visits. This can mean that they are not being adequately treated, at best, and at worst, they are abandoned by society. Often they are the homeless meandering our city streets, until law enforcement rounds them up for a minor offense (misdemeanor), which lands them behind bars in city or county jails. Coupled with that, most states don’t have well funded state run mental health facilities; forcing the government to keep these patients locked up. A paradigm shift has to happen.

One technological advance might make it cheaper to choose preventative medicine over urgent care: DNA testing. Since the human genome has been decoded a whole cottage industry has emerged. There are many different companies which will test your DNA for not only your ethnic add-mixture, but also genetic disease screening. Naturally, the price vary but for around $300 you can have your DNA tested for hereditary illnesses.

While this seems like a panacea to the staggering costs of preventative healthcare, there are some worrying cracks in the foundation. Questions like, how are the digital health records of patients kept private and secure? Who will have access to the DNA records? How can we safeguard against cyber attacks and big data leaks? There are no clear answers. But what is crystal clear, is that the US federal government needs to get a grip on making healthcare affordable for all her citizens.