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ACA vs. Repeal/Replace

For better or worse; for richer or poorer; in sickness and in Wealth? What are the consequences to employment in the health sector if President T...
ACA vs. Repeal/Replace

For better or worse; for richer or poorer; in sickness and in Wealth?

What are the consequences to employment in the health sector if President Trump follows through on his campaign promise to repeal the Affordable Care Act? That may not be as big a concern as we once thought… Instead of abolishing it, his language has changed from "repealed" to "amended" to "repair & replace" so now, though no one knows exactly what's going to happen, it appears that millions won't be left without coverage.  

Maybe his solution will be worse than former President Obama's plan; maybe it will have the same net-effect; hopefully it will be even more comprehensive and better. We're going to have to wait and see.

Repeal would hurt the health industry

There's no doubt that the complete repeal of the ACA would result in many people not being able to afford healthcare. Fewer people would see doctors; fewer patients would mean lowered staffing requirements for clinics. Doctors' incomes would see a consequent decrease, as would the total number of employees in the health industry.

The new President doesn't want to alienate a very wealthy sector of the population (medical professionals) or cost the sector innumerable jobs. Nor would Big Pharma be too thrilled about a 25% drop in prescriptions for the expensive pills they sell, either.  He's a businessman, as he's often proclaimed, and he's got "good people", so hopefully he'll get good advice.

Where did all this come from?

The United States has always placed a high value on being staunchly independent; on standing apart from the crowd; on the value of the individual being able to determine his or her own highly customized future.  

Being afforded that opportunity some people have profited immensely. Good for them! We reward those that are the first to do something; who improve a process; and particularly, those who do something better than anyone else.

Sometimes that encourages them to spread the wealth among those they deem to be deserving of their aid (e.g. the Bill and Melinda Gates Foundation). On the other side of the coin, sometimes successful people are more like Ebenezer Scrooge, simply valuing their wealth for its own sake. Generally speaking, we appreciate the people that share their wealth more than the people that hoard it.  

Historically we had no say in that, of course; it was entirely up to them what they chose to do with it. At least it was that way until universal taxation came along. You can't just have a government; you need to develop rules, processes, and laws, to make it all function, and of course it needs to be financed.

But once you have a government where do you draw the line about what should be covered and what shouldn't? Roads? Sure!  Hydroelectric dams? Absolutely! Healthcare? Um… let me get back to you on that!

Gambling with our health

Insurance/Assurance has existed for very long time.  Mathematicians (actuaries) would study history and calculate the odds against an event and offer to compensate people who experienced that event against a flat wager placed at the beginning of the term.  It's actually a socially acceptable form of gambling.

Some people became very good at calculating the odds and turned it into a profitable business model.  As civilization advanced around the world, some individuals thought the service ought to be regulated by the government as a fundamental human right.  Profits were too high, they claimed, especially being based on human suffering.  Many governments elected to provide a basic healthcare package for all of their citizens.

In most of the developed nations of the world, irrespective of politics, basic healthcare is provided to citizens.  If you need medical care in France, you just call the local Health Service and a doctor will come to your home or office and provide treatment. S/he can admit you to hospital on the spot. If you get a prescription, for any drug you can get it filled at any pharmacy for between 0-65% of the cost. This is true for most of Europe. 

The same is true in Cuba…just walk into any hospital for free treatment for everything from the flu to prosthetic limb replacement.  England has this, as does Canada, and the ABCs of South America (Argentina, Brazil, and Chile).  

North and South America have a total population of just over one billion people.  Of the 414.7 million in South America, 60% are covered by public health.  Mexico's 122 million are well on the road to Universal Healthcare, starting with healthcare for babies far back in 2006, and Universal Care for Pregnant Women in 2009.  The 35 million in Canada have been able to get heart-lung transplants for the cost of a bus ticket to the hospital since the 1960s.

Once again, the U.S. stands alone, resisting Universal Healthcare, while virtually all other developed and developing nations embrace it. Our independent spirit has moved us through history, accomplishing astonishing things, often setting the best example for the world to emulate.

We have to ask ourselves: "If we're the Greatest Nation on Earth, shouldn't we be showing the world how to do it better than they do it?"  We're not followers; we're leaders!

We need to show them that we can create a low cost, sustainable, inclusive, healthcare plan for everyone; where citizens don't expire on the street because they have no access to Medical Care; where our famed American-Know-How gets the job done without all the pointless partisan politics; where we don't have a mass exodus of our medical professionals to another country, searching for job stability, as happened in Venezuela.  

If we're doing the job right, we should be increasing the number of people in the medical profession.  Why?  Right now we currently have about 240 per 100,000 of population, compared to 590 per 100,000 in Cuba, and 425 in Russia.  Medical care is far too expensive and inaccessible to a large portion of our population compared to other countries, and therefore we have fewer medical professionals.  Currently we stand at number 52 in the world—and isn't that unacceptable for the Greatest Nation on Earth?

What will likely happen

  • Drug patent monopolies will change.  The United States is the only country that provides extended patent drug monopolies without price controls.  As a result we pay more for our drugs than any country in the world.  This isn't a "free market" issue, since it involves a monopoly;
  • We may allow the import of medication from overseas manufacturers to put downward pressure on the price of drugs in this country;
  • If we end up paying an obligatory premium (tax) on our paychecks to cover Universal Health Care, that will be fully deductible from our income taxes;
  • There should be a schedule created of prices for medical procedures.  Anyone staying within the system will pay the same as anyone else for the same treatment.  We should eliminate "charging whatever the traffic will allow";
  • With diversified providers you get increased competition and better prices.  A Federal decision to allow Medical Insurance to be purchased by anyone, anywhere, and be valid in all states will decrease costs.

The Takeaway

For fans of Obamacare, it may end up being called Trumpcare, while the remaining largely the same. It might be a little worse; it might be vastly better. The good thing to remember is that it is probably not going away.

President Trump is all about investors and business people; and at this point, they're getting really tired of playing the role of yo-yo in this political game.  He's got to offer them some stability so they can make sensible investment decisions.  That means that Medicaid expansion will probably continue; laws and regulations which have been created to help the health industry (with notable positive effect) will stay in place.  

The expansion of Home Healthcare will probably continue, since it is often as effective as care received in a hospital or a skilled nursing facility.  Visiting Doctors, Nurse Practitioners, Nurses, and other healthcare workers are far less costly that stays in a facility, and this increases employment opportunities in the medical field rather than decreasing them.

Once all the dust has settled, the number of people in the medical industry should maintain its normal growth rate based on an increasing population, or perhaps increase compared to the population, providing faster service to increasing numbers of people accessing the service.

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