We are all wondering what will happen in healthcare following the recent election. The Republican party has control of the Presidency, Congress and 35 Governorships with a majority but not full control of Senate. The question is what will they do with this power?

Whatever they decide to try the problems remain the same. As a nation the US spends more per head on healthcare than any other and yet has worse levels of health and outcomes, so the system has to be made more effective.  But taking out cost is not the only answer; the healthcare system still has to paid for. In most other industrial countries healthcare is paid for by a tax (like the Social Security tax) on people who are earning while in the US costs fall on everybody who needs care, earning or not. Not that this is perfect; the National Health System in the UK is suffering all kinds of resource crisis and lapses of care.

A major issue is the unequal use we all make of the healthcare system we have.  According to the Kaiser Family Foundation the 1% of Americans who use healthcare the most account for 25% of total healthcare costs, the 5% who use the system the most account for 45% of US healthcare spending. These are the so-call “super utilizers”, often  poor, with multiple conditions, many drugs and using emergency rooms for care. Even so, only 50% of Americans are accounting for 97% of all healthcare expenditure. The key question is how do we get the 50% of people who make little or no use of  the medical system pay for the rest? The last administration tried to do this by tax breaks and a “fine” on those who did not have insurance. The Republican philosophy is likely to emphasize consumer choice, competition and selective tax breaks by extending Health Accounts.

President Trump has announced that he is close to completing a plan to extend health insurance to all, and it is clear that the Republicans wish to keep key elements of the Affordable Care Act including no refusals for pre-existing conditions.

So we tried it one way  and now it seems we will try in another way. No matter what the problems remain the same.

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