Fifteen years ago, public affairs were alive with a great debate over American health care and the financial means by which it was provided. The status quo was not quite free enterprise but the proposed replacement was not single-payer socialism either. The result—voted in with exclusive support by one political party—was essentially a wish list of dreams and delusions.
Here we are 15 years later and every major institution associated with medical insurance and provision has adapted to it. However, the premiums on insurance are skyrocketing, along with huge deductibles. It’s cheap to use for a routine visit. The instant you need tests or specialists or something else, the insurance feature disappears.
With expiring subsidies, we are to experience astonishing increases. And this happens just as the health of Americans is at an all-time low, with new weight-loss pharmaceuticals in high demand and record chronic illnesses combined with an aging population.
For the Trump administration, this is a huge problem. It is all well and good to blame past presidents and the other party. But the political reality of our time is that the Republicans own the system. Anything that goes dreadfully wrong falls to them and it becomes something for which they must take responsibility.
Cooler heads will point out that nothing about Obamacare was sustainable. The idea was to create huge risk pools and extremely generous benefits and let everyone share in the burden. The larger the pools, the more that preexisting conditions and high-cost consumers could be buried in the premium noise.
This is the kind of plot that works for a few years before it entirely blows up. By removing the actuaries from assessing individual risk, people also lost the will to health because there was and is no financial benefit associated with a change of lifestyles. Indeed, all the financial incentives are in the reverse: The system makes the most money from people who are sick but have access to financial means to keep paying for more treatment.
Consider this:
Since the passage of Obamacare, America has seen a complete reversal in public health progress. In one-third of that time period, public health had a near monopoly on the control of people’s lives, deciding even the size of house parties and whether businesses could be open.
In this period, medical spending overall ballooned to $4.9 trillion in 2023—more than double the per capita average of other high-income nations—and outcomes have stagnated and worsened. Meanwhile, out-of-pocket expenses for consumers have doubled. This is what is called affordable?
Life expectancy at birth peaked at 78.9 years 10 years ago but has since declined or stalled, erasing decades of gains. By 2023, it was 78.4 years—a mere 0.9-year rebound from the pandemic low of 77.5 in 2022. This represents a net loss of about 0.3 years over 13 years.
Half a million more people died in 2023 than could have been expected based on 2010 trends. The shot? Surely that is a contributing factor but underlying health also figures into this. This kind of vital data is a dreaded sign, that which you would expect to see in a nation in crisis.
The great irony is that the one indisputable success of Obamacare has been to increase access to medical care. More people are insured than ever before. The usual presumption is that this should be a good thing. But what if the kind of care matters even more? Doctors are ever less in charge while the insurers themselves determine most detail concerning treatment.
Adult obesity in this period rose from 38 percent to 40 percent, with severe obesity going from 7.7 percent to 9.7 percent. This is getting dramatically worse in real time. The expectation is that by next year, 64 percent of adults will be overweight or obese.
Mental illness now affects something approaching a quarter of adults, while 40 percent of high schoolers report persistent sadness/hopelessness, and 20 percent have considered suicide. Remember that Obamacare mandated that mental health coverage was included in all benefit packages. That seems to have made matters worse.
This is a grim picture: A nation pouring resources into healthcare yet yielding shorter, sicker lives, especially for the young, poor, and marginalized. Some people are getting rich off sickness while the rest of us are being pillaged.
We cannot keep doing the same thing over and over. Politically this is extremely dangerous for Trump for the simple reason that it is all occurring under his watch and while Republicans control the House and Senate.
This talk about the “Golden Age” needs to stop and all efforts need to be turned to a fix. Trump is correct to redirect all government subsidies from Medicare and Obamacare to individuals themselves. After that, all individuals regardless of health insurance status need access to health savings accounts (HSAs) which should be run like any savings account and offered by any and all financial institutions.
The money in these HSAs should be available for investment purposes and be spent on anything health-related, and that includes naturopathic and homeopathic treatments or anything else. The dramatic opening up of the medical marketplace will subject it to the cold winds of competition and drive down prices immediately.
Moving vast swaths of generics out of prescription and onto off-the-shelf will relieve people of the burden of physician dependency. And physicians who choose to leave the insurance matrix and become direct primary care need to be free to do so.
Finally, it is urgent that employees and employers be permitted easily to opt out of jobs-mandated health insurance. This system disguises costs and enables huge increases. It also interferes with relationships between doctors and patients because the doctors work for the insurers who are dictating outcomes.
There is a real tragedy unfolding here. Trump and the Republicans are going to pay a huge political price for the failure of the system they had nothing to do with passing. It has not worked, and now it is blowing up. If the Democrats regain control, the reform they will pursue will be single-payer socialism that will make a terrible system even more unusable.
Republicans have a window of opportunity to smash the status quo. They should and must seize it.
