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We’re entering a year of unknowns

January 19, 2017   ·   0 Comments

CLEARLY, THERE’S NO PRECEDENT for many of the things happening in the United States as it enters the “Trump era.”

Never before have we witnessed the intelligence community concluding that Russian President Vladimir Putin directed hacking operations designed to defeat Hilary Clinton’s bid to become the first female president of the world’s most powerful nation.

Never before have we seen the inauguration of a U.S. president who had never held political office or served as a leader of the armed forces and whose fame stemmed from hosting television shows.

That being the case, it’s really anyone’s guess as to what Donald Trump will wind up accomplishing in his first four years in the White House. His election-campaign promises include building a wall along the border with Mexico, at least temporarily banning the immigration of Muslims and deporting untold numbers of the estimated 11 million U.S. residents who are in the country illegally.

However, few of the 300-million-plus Americans will be affected by such moves, and his promises to tear up trade agreements and erect tariff walls won’t find much sympathy with the Republican majority in Congress.

But one place where all Americans will wind up either winners or losers is health care, and it’s a place where no one seems to know what Mr. Trump meant when he told the Washington Post last week that affordable health insurance would be made available for all Americans.

“We’re going to have insurance for everybody,” he said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” He declared that those covered under the planned law “can expect to have great health care” and that it would also be “in a much simplified form. Much less expensive and much better.”

The Affordable Care Act, commonly known as Obamacare, includes universal availability, but only half the 40-million Americans who had no health insurance prior to its passage in 2011 have signed up, and the cost of health insurance has soared because of its requirements that no one be denied the insurance because of a pre-existing health problem and limits on premiums charged the ill and elderly.

Clearly, the main problem with Obamacare is that no one must purchase the insurance, the result being that the 20 million who didn’t saw no need, because they were young and healthy.

Both Republican-dominated houses in Congress have passed legislation setting the stage for repeal of the Affordable Care Act, and the U.S. Senate has instructed four committees  to draft repeal legislation by January 27.

Perhaps the new president’s inaugural address tomorrow will include some clues as to what he has in mind, but it’s hard to see how any health insurance scheme that is only universally available and maintains Obamacare’s main features will be affordable without the participation of the young and healthy.

For strong supportive evidence, all one need do is see what the Ontario government discovered when it introduced such a scheme, dubbed the Ontario Medical Services Insurance Plan, in the mid-1960s. The plan permitted the continued availability of private health insurance while allowing Ontarians to choose the public scheme, which included a means test for the poor. The result was that OMSIP ran huge deficits, with the private insurers being able to choose healthy, young subscribers. By mid-1969 the Progressive Conservative government of the day opted to replace OMSIP with OHIP (the Ontario Health Insurance Plan), which came into effect on November 1, 1969, qualified for federal grants and provided for a single, publicly financed source for payment of doctors’ fees and hospital costs.

Don’t be surprised to find that what Mr. Trump has in mind is a multi-tiered plan with an option of low fees and only basic health services aimed at the young and healthy. But even if that’s the case, would they all buy in?

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