The Washington Post is apoplectic in its coverage of President Elect Donald Trump's weekend promise to replace the Affordable Care Act (ACA) aka Obamacare with what sound like universal healthcare coverage. The tenor of the article suggests that Trump's own Republican Party have no intention of providing the kind of coverage implied in Trump's vaguely worded promise. But what if...?
The Trump 'promise'
First, here's how WashPo reported Trump's 'promise:'
“We’re going to have insurance for everybody,” Trump 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.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” …
“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.
...and then editorialized it as follows:
We should begin with the assumption that nothing Trump says can be taken at face value; the “plan” that he claims is being devised could be no more real than the secret plan to defeat the Islamic State he used to claim that he had formulated. But that’s not the point. What matters is this: Donald Trump just emphatically promised universal health coverage. That’s an absolutely gigantic promise, and it’s one that Republicans have no intention of keeping.
But now they’re stuck with it. Democrats will be saying, “President Trump promised that everyone would be covered!” every day for as long as this debate goes on. Every time a congressional Republican is interviewed on this topic, they’ll be asked, “President Trump said that everyone would be covered. Does your plan do that?,” and they’ll have to bob and weave as they try to avoid admitting the truth.
That’s because the Republican plan, in whatever final form it takes, will absolutely, positively not cover everyone. Universal coverage isn’t even one of their goals. Republicans believe it’s much more important to get government as far away from health care as possible. In place of the ACA’s expansion of Medicaid and subsidies for the purchase of insurance that have extended coverage to 20 million more people than used to have it, they’ll be offering some tax credits and health savings accounts, which would be very good for the healthy and wealthy, but not so great for other people.
The systemic problem
US healthcare is a massive political football that makes the excess of Superbowl weekend pale in comparison. .
The difficulties stem from the fact that the US version of democracy is based upon a capitalist view where the execution of every policy comes down to some sort of dollar value allocation. Healthcare is firmly in that tradition as a 'for profit' industry, yet despite that ideological view, US healthcare is the most expensive yet one of the most inefficient systems in the world.
It is this twin problem of both access and cost that Trump believes require addressing.
Set aside whether you believe Trump or otherwise, and even his own party think he is blowing smoke, the simply expressed Trump proposition would be enormously popular and serve to allay many of the healthcare related fears that have emerged since Trump was elected. Add in the fact that Trump has mastered how to impact pharma stock prices with his Twitter account and you have the prospect of an interesting scenario playing out.
The wrath of Congress?
The question is how any of this is do-able without incurring the wrath of vested interests that are part and parcel of American political life? Last week, Congress voted down proposals that would have allowed US citizens and pharmacies to source medication from Canada at lower cost than is the case in the US. Here is how MoneyBox, Slate reported the problem:
So why come out against such a worthy and clearly popular endeavor? Isn’t it exactly the thing to vote for to show you care about the economic woes of Americans, not just those who are less than happy with the Affordable Care Act? Well, Jezebel’s Ellie Shechet helpfully points out, Booker and a number of the other Democratic senators who said nay are among the biggest senatorial recipients of pharmaceutical contributions between 2010 and 2016.
See what I mean about the power of the almighty dollar? But now, with the added frissance of Trump's pronouncements, change may become inevitable.
Say what you will about Trump's Twitter ramblings, incoherent pressers and questionable personality, this is what Trump is reported to have said when talking about the proposals:
Trump warned Republicans that if the party splinters or slows his agenda, he is ready to use the power of the presidency — and Twitter — to usher his legislation to passage.
Where will this leave 'legs and regs' in HR systems? The short answer is: in need of considerable overhaul. Whether Trump's rhetoric translates into a revised form of co-pay, adjustments to employee and employer contributions, revisions to what is 'taxed' at source, there will be significant required work in back end HR/payroll systems. And all that's before considering the cost impact in the working economy.
What will this mean for companies like Zenefits, which has a business model predicated upon providing free HR back office functionality but supported by premium splits with insurance companies? Nobody knows but you can be sure that if Trump wants to bring the cost of healthcare down, then premiums must fall and that, in turn, will mean lower per capita revenue for Zenefits.
What will it mean for healthcare automation? This is a topic that has long been mooted with talk about sensor tech in the operating theater and so on. But then healthcare has been comparatively slow to adapt to the new opportunities presented by automation techniques. My hunch is that progressive providers will use these types of 'threat' as a good reason to perform their own preventative medical treatment by way of evaluating cost cutting options, facilitated by automation.
The current media mood is little short of hysterical. On the one hand Trump is laying down a path of fire for everyone to walk over. On the other hand, the simple appeal to a nation that has for too long, been yoked to ever increasing healthcare costs has to be taken seriously.
As I've said before, this may be the first time in a very long time that those of us who are engaged in the technology industry have to seriously evaluate the impact of political maneuverings as part of our efforts to second guess the next steps in technology evolution. Why? The cataclysmic changes implied by Trump's pronouncements on healthcare alone are, in US terms, truly revolutionary.
If Trump gets even half way towards delivering, then this might be what he really meant when he talked about 'draining the swamp.' And that would be a good thing for everyone. Provided, of course, that Trump is both serous and capable of delivering on his promises.