The real reason Trump can’t fix Obamacare.

When I was a little kid I became obsessed with the idea that if I had really strong suspenders I could jump really high and maybe even fly. Well that didn’t work. And that is the real reason health care plan fixes and Obamacare modifications wouldn’t work either.

We are in a pickle with health care, and President Trump is another galaxy  away from understanding that.

For as long as memory serves me, health insurance premiums have been in an upward spiral, regularly leading every component of the cost of living index. No mystery here, these premiums were simply keeping up with the incessant cost uptrend in primarily treating chronic illnesses and with end of life care. It was simple to predict, even twenty years ago, that there was an unsustainability to future health care spending.

Perhaps it was futile for Obama to attempt to fix healthcare, or some part of it.. The law attempted to bridge two central issues, one, the plight of the uninsured and uninsurable, and two, to redirect people to be healthier by incentivizing preventative care, which is why that kind of care is not subject to a deductible..

There were also provisions, which Trump and republicans don’t  talk about, capping insurance company profits to 15% of the plans’ premium cost.  This included administration, sales and marketing costs, etc. Thus, whatever premium increases we see in Obamacare pretty much reflect the claims experience of the insurers and the insureds. We did note that the new, though withdrawn (really failed), Trumpcare proposal, increased insurer’s profit to 20% (an enormous 33% increase). We also wondered how many Trumpster insiders recently purchased health insurer companies, such as Aetna, in there non-blinded or affiliated investment accounts.

Any program requiring insurance companies to accept all comers had to address the issue of adverse selection against them if pre-existing conditions are waived.. Thus, Obamacare can only work if adverse selection is mitigated by the requirement for everyone who doesn’t elect to have health insurance, or doesn’t get it through employers, Medicare, or Medicaid,  pay a tax  penalty.  But what if they can’t afford to enroll? Presto,, tax credits to help them pay the premium.

Indeed, one could say that Obamacare’s premium increases are not due to anything but that people are sick and becoming sicker,  because even people who did not have pre-existing conditions are quite often not in thriving health,. and modern medicine is expensive.

Our healthcare system, alas,  is not broken, as some say. Rather, our healthcare system is based on the oft reinforced false premise that major chronic illnesses are not primarily self caused and can be effectively addressed by pharmaceuticals and other extraordinary (and costly) treatments..The heck with good diet, exercise, and healthful lifestyles.

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