President Donald Trump and his allies in Congress are trying to push through a major healthcare bill right now: the American Health Care Act, or AHCA, which would repeal and replace Obamacare. The AHCA has plenty of fans and plenty of detractors, and that’s no surprise: American healthcare is immensely complicated.
Employer-based system and government safety nets
If you’re an American with health insurance, there’s a good chance that you got it through your employer. That’s because America has long had an employer-based healthcare system, wherein health insurance is expected to be one of the benefits we receive (in addition to salary) from our employers.
That’s all well and good, but there are some obvious pitfalls here. If you get fired, for instance, you’re going to have to really hope you’re not sick. And what about when you retire?
Americans have long been able to buy healthcare individually and for their families outside of employee benefits, but these plans can be pretty pricey, and some of our most vulnerable citizens – including the poor and the elderly – may find them out of reach. So the government stepped in and created safety nets for those citizens. Into a market full of private insurers, the government stepped in with Medicare and Medicaid. More people were covered, but coverage still wasn’t complete – and even those with Medicare often needed supplemental insurance – called Medicare supplement plans – to cover additional costs, a situation that still exists today.
With so many people still uncovered. Liberal politicians pushed for universal healthcare and finally got with the the ACA (Affordable Care Act), arguably President Barack Obama’s biggest accomplishment. “Obamacare,” as it became widely known, worked within the existing (and complicated system): it expanded the obligations of businesses with few workers or part-time employees, while also demanding that individuals all get healthcare or pay a fine. Some business owners cried foul, but the ACA gained plenty of fans, too, as it expanded healthcare to new segments of the population.
Crucially, the ACA prevents health insurance companies from denying coverage for pre-existing conditions. On the flip side, it forces everyone to enroll – including healthy and young Americans, who too often skipped health coverage before the ACA.
Drugs and drug companies
As complicated as health insurance is, it’s only part of the American healthcare system. There is a whole other set of regulations covering pharmaceutical products, including over-the-counter supplements and prescription drugs.
American drugs have a whole history of their own, which led to the creation of the FDA in the early 1900s (the FDA had a few predecessors, but none had the power the FDA got under Teddy Roosevelt’s Pure Food and Drug Act.
Now many drugs have to be approved by the FDA, and claims about the powers of medications are checked by experts. But even here, there are still weird and overlapping situations. Take the booming supplement industry, for example, which features largely unregulated products that don’t include substances or (at least in theory) make claims that would necessitate government intervention. This leaves citizens to decide for themselves what supplements will work best for them: there are whole websites devoted to breaking down the . Some supplements, like vitamins and certain basic workout drinks, are helpful. Others do not have proven benefits. This category contains everything from protein powder to “natural medicines,” and it’s surprisingly unregulated.
Complicated solutions for complicated problems
Healthcare has been complicated throughout American history, and it shows no signs of getting any less so. A complete revamp – like the transition to “single-payer” universal healthcare that many liberal politicians would prefer – would be very difficult, thanks in part to the huge number of stakeholders that our strange system has created: private health insurance companies, benefits brokerages, and so on. (Single-payer would put the government in charge of everything, which would mean throwing out huge chunks of our current public/private system – costing a huge number of jobs and a massive amount of money to an industry that has a lot of lobbying power. So it’s no surprise that Obamacare left plenty of room for private insurers.) And, for that matter, the conservatives in power would like to move things in the other direction: towards a more privatized system with less government involvement. In other words, our messy public/private system is going nowhere fast – and it may even be getting more complicated.