Patients and Their Doctors Can Talk Again

A physician weighs in on how Obamacare reform can work in the wake of Trump's win

by Rob Tenery | Updated 10 Nov 2016 at 7:14 AM

Donald Trump’s victory in the presidential election will change the dynamics of how this country evaluates the future funding of health care services.

Instead of moving toward a single-payer system, where all payments are under the purview of the federal government, there is real opportunity to turn some decisions back to the providers and the patients themselves.

The creators of the law knew, almost from the start, that their plan to cover the uninsured was probably doomed to failure.

The flaws in the Affordable Care Act were that it was no longer affordable, as coverage rates are scheduled to increase an average of 25 percent across the nation in 2017 — and the promise of keeping the doctor of one’s choice never materialized once the law was enacted.

The sad irony is the creators of the law knew, almost from the start, that their plan to cover the uninsured was probably doomed to failure. The rationalization for forcing their plan through Congress was that if the proposed legislation failed, the move into a single-payer model would be relatively easy.

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Trump’s campaign promise was to begin the repeal process of Obamacare on the first day of his presidency. With Republicans maintaining control of the House and Senate, success seems likely. Since the law was launched, RAND estimates there were 22.8 million newly insured, while 5.9 million lost their coverage during that time. The net works out to be a gain of 16.9 million people. While Trump has promised to do away with Obamacare and put in a new system, the people who now have the security of health care coverage cannot be forgotten.

Related: What Illegal Immigrants Cost Our Health Care System

The inherent problems with Obamacare are that it made the assumption that the employer and individual mandate provisions, along with the expansion of the state-run Medicaid programs, would fund the millions of newly covered lives. The legislation didn’t live up to expectations for several reasons: Nineteen states didn’t buy into the president’s plan. Many employers cut back the number of their employees or reduced their hours, converting them to part-time. And Obama’s individual mandate clause is not severe enough to force enough younger and healthy individuals to obtain coverage rather than paying the relatively innocuous fine.

There are several social and economic realities that doomed Obamacare from the start:

1.) The patient was taken out of the decision-making process, with no incentive or disincentive for financial responsibility.

2.) There was a failure to develop an affordable basic benefits package of health care services that would be available to all, through expansion of the state-run Medicaid programs, medical savings accounts, vouchers, and allowing the private health insurance carriers to compete for patients across state lines.

3.) Similar to automobile liability insurance, Obamacare is mandated personal coverage with punitive penalties that are persuasive enough to force compliance under an individual mandate regulation.

It may too late to totally repeal all of Obamacare. A Medicare-for-all system that turns over our health care system to the federal government is equally bad. Somewhere in the middle, where patients are brought back into the decision-making process with expanded funding mechanisms, will go a long way toward helping our uninsured and underinsured.

The idiom of "throwing out the baby with the bath water" comes to mind here. This country has come far in addressing health care coverage. Now is not the time to go backward, but to bring the providers of health care and their patients into the decision-making process and reintroduce competition among the private health care carriers to build on what has already been accomplished.

Related: It's Not Too Soon to Start Overhauling Obamacare

On Tuesday, the public spoke loudly and clearly. It's time our representatives in Washington listen.

Rob Tenery, M.D., is a Dallas-based ophthalmologist and writer, and the third in three generations of physicians.

  1. Affordable Care Act
  2. Dr. Rob Tenery
  3. Medicaid
  4. Medicare for All
  5. Obamacare
  6. uninsured
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