William Seligman and Mataroria Lyndon: Making American healthcare great again?

donald_trump2After eighteen months of breakneck campaigning, there are few who would have predicted the results we saw in the United States presidential election last night. Donald J. Trump, described by President Barack Obama as the “single least qualified candidate for the presidency in the history of the United States,” swept to victory winning traditional conservative states and flipping liberal strongholds. What’s more, the Republican Party now has majorities in both houses of Congress—the Senate and the House of Representatives. Last week, we discussed what we thought might happen given any number of presidential and congressional scenarios. Never did we think we’d be writing again today to discuss the implications of a Trump White House, Republican-majority Senate, and Republican-majority House. But here we are and what does this mean for healthcare in America?

  1. Obamacare to go

We don’t know much about Trump’s plans for healthcare but what we do know is that he is committed to complete repeal of Obamacare. He’s even said he will organize a special session of Congress to dismantle Obamacare “immediately.” With a Republican congress united behind complete repeal, Trump will likely get his way. However, the Senate tradition of the filibuster—the process by which a senator is able to delay voting on an issue for as long as he/she can physically talk—means that repeal will not be quite as straightforward or as swift as Trump might envisage. That said, Obamacare is going to be a thing of the past. What happens to the 20 million previously uninsured Americans who got coverage through Obamacare? Anybody’s guess.

  1. Attempts to reduce health insurance premiums

Trump used his stump appearances to lambast Obamacare for its part in raising the cost of insurance premiums for millions of Americans. How will Trump manage to keep the insurance companies and their premiums under control? The basic economic principle of competition and free markets. By allowing the sale of insurance across state lines, Trump hopes that as the number of insurers increases, prices will be driven  down. We have also heard Trump talking about allowing individuals to deduct the cost of insurance premiums from their tax returns. How will he pay for this? Anybody’s guess.

  1. Attempts to limit the availability of birth control

One of the reasons why this election has got people so fired up on both sides is that it’s likely that this president will nominate anywhere between two and four Supreme Court justices during his tenure. Supreme Court justices serve for life and so this president has the opportunity to influence the judiciary branch of the government for a generation. What has Trump said about the Supreme Court justices he will nominate? For starters, he’s committed to appointing justices who are opposed to the Roe v. Wade ruling that allows women the right to abortion. Should Roe v. Wade be overturned, states will likely have the opportunity to determine the legality of abortion. According to a 2007 report, 21 states are highly likely to ban abortions with a further nine likely to follow suit.

So, we’re going to see significant changes to the US healthcare system over the four or eight years of a Trump presidency. Changes far more sweeping than many could have ever predicted. Changes that may affect an entire generation of Americans. The election results are a function of the American people more than the views or values of any individual candidate. America is more divided today than ever before. Maybe Obamacare wasn’t what the American people wanted. But let’s hope President Trump and the Republican leadership find a solution to America’s great healthcare challenges.

william_seligmanWilliam Seligman completed his Foundation Programme training in the Severn region before embarking on the Master of Public Health program in health policy at the Harvard T.H. Chan School of Public Health. He was previously a Legislative Intern in the United States Senate.



m_lyndonMataroria Lyndon is a physician completing a Master of Public Health in health policy at the Harvard T.H. Chan School of Public Health. He was previously a Clinical Lead at Ko Awatea, Counties Manukau District Health Board, and a PhD Candidate in Surgery at the University of Auckland, New Zealand. 

Competing interests: None declared.

  • Roger

    As a physician having practiced in Seattle for 15 years followed by a return to Canada for 15 years I have been under both medical systems. The Canadian healthcare system is badly failing the patients as well as the healthcare providers. While the non-clinical layers of bureaucracy grow ever deeper and siphon money away from those who need it we must try to provide patients care with a lack of resources, excessive waiting lists, minimal efforts at quality outcomes, extremely poor personal connection to patients, a union mentality by most workers within the system of doing the minimal amount of work ad not rising up to meet the needs of our patients. The list of examples – both large and small would be far too long to write down. However, a brief summation would be that the free market forces in the US force hospitals and providers to compete with each other and be the best they can be. If I am a hospital with the lowest infection rate that is a big advantage to a patient or insurer. If I am a physician who actually gets along with patients, calls them back, treats them compassionately and actually cares about them I get new patients by word of mouth. In Canada, since there is a shortage of providers there is no need to worry about new patients therefore why not treat them like cattle and rush them in and out quickly writing a prescription and moving to the next one. The single-payer model provides both the resources and the payments to providers. This conflict of interest is completely apparent as they fail to provide needed resources (i.e., enough MRIs, lack of OR time, reduced budgets for hospital staffing, etc.) which means they are effectively rationing care, keeping money in their own pockets and blaming it all on other factors. While it took Canada several generations to deteriorate to its current level it becomes obvious that with the amount of money on the table it will be almost impossible not to see the ACA (Obamacare) eventually degenerate into the same thing. The massive waste of money this would devolve to would crush the country. Once it becomes apparent that it is not a sustainable model then the rules start coming – no kidneys for anyone over 65, less aggressive therapies for older citizens, limits on certain pharmaceuticals because of cost, lack of coverage for new therapies, etc., etc. There is minimal personal patient accountability – “everything is free, right”. The key thing the Canadian model has is that there is a safety net for everyone. The problem is they started out believing they could offer it all to patients and there is simply not enough money to do that. If the US can find a way to provide a very basic level of care then educate the population on personal responsibility for their own health they may have a chance.