While most industrialized nations have government paid, ‘single-payer’ health systems, the United States is a sole outlier. The US system is far more complicated than any other in the world, as it features the competing interests of providers, pharmaceuticals and insurers.
The tug of war between these factions often leaves consumers – the people, in other words – stuck in the middle. Insurers fight with doctors and hospitals to keep health-care at a reasonable cost; pharmaceutical companies want to charge as much as possible for medication, to cover the high R&D costs it requires to make a viable medicine. This whole process is a messy, complicated and ruthless system that ultimately affects the low and middle class the most.
The Affordable Care Act, aka Obamacare, was supposed to create a market-based solution to the issues that existed. Instead, Obamacare mandated people buy private insurance, in the hopes that it would make insurance cheaper. So far, though enrollment in Obamacare has been strong, the cost of healthcare is not getting cheaper.
This has made ‘health-care’ a major issue in the upcoming presidential elections. “Health-care” is a misnomer, of course, since America has the finest doctors in the world; the issue is not getting care or the care provided, but affording the care or affording the insurance that covers part of the cost of that care.
The Republican front runner, Donald Trump, points to a market-based solution: get rid of unnecessary legal barriers. In specific, health-care is not transferable across state lines. A resident of New Jersey could not buy a policy from Pennsylvania, or vice versa, even if a Pennsylvania policy is 25% cheaper. State exchanges were actually supposed to be a key feature of Obamacare originally, but that was eventually edited out of the final bill package. Trump accurately says that opening up cross-state competition would decreases costs substantially, and there is every reason to suspect he may be correct: his plan would not halt the spiraling costs, however, it would merely alleviate it somewhat or slow it slightly.
The Democratic candidates offer two alternative solutions. Hillary Clinton, the front-runner, has spoken of her desire to take the ACA/Obamacare and add some structural tweaks to strengthen it. Her opponent, Bernie Sanders, is advocating to change the system completely: uproot what exists and replace it with a European health system. This would mean an overhaul of the entire existing apparatus, from the local doctor to the largest R&D lab of a pharmaceutical company.
The issues are manifold. Sanders’ is unlikely to get the sweeping healthcare he wants. The Republicans could likely get their plans passed, but they would do very little to fix the health-care problems. Clinton is effectively advocating for the status quo, which is insufficient.
The situation is complex. The greatest obstacle to increased health coverage is profit motives. Adding government might not be the best solution. The status quo is also untenable in the long term. The only ‘clean’ solution would be restructuring for-profit healthcare into non-profit healthcare. That means having doctors, pharmaceuticals and insurers all working to cover costs, instead of turning a profit. That adjustment would likely cut costs tremendously… but it’s extremely unlikely to happen voluntarily, and there is no political will to force that sort of change.