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Editorial - Issue No.3, 2016

Ian Ellul - Obamacare Vs trUmpcare


The US Presidential election will be held on 8 November 2016.  There are two contenders, the billionaire 69-year old Donald Trump [Republican] and the millionaire 68-year old Hilary Clinton [Democrat]. Trump represents a conservative party and indeed seems to be more conservative than Clinton in all spheres. However, conservatives are facing a Hobson’s choice. The reason for this is that Trump seems to be the most liberal candidate in the party’s history.  It is been rumoured that if Trump wins the election, the Republican Party will become essentially what the Democratic Party of the 1990’s was under Bill Clinton.

Representing two opposing parties, quite naturally, Clinton and Trump have divergent views on a number of key issues, one of which is the future of Obamacare. Whilst Clinton wants to improve Obamacare, Trump wants to repeal it. However, before proceeding further, it is important to illustrate the current state of affairs relating to healthcare in the US. One of the landmark reforms relating to healthcare which have been implemented in the US is the Patient Protection and Affordable Care Act, also known as Obamacare, which in 2010 reformed Medicare, the latter being in existence since 1966.  Obamacare enacted a comprehensive system of mandated health insurance with its aim being extending health insurance coverage to those who lack it, including those people who receive no coverage from their employers, the poor and the elderly. To achieve its aims, Obamacare offers subsidies to make insurance coverage more affordable and also creates marketplaces - with websites similar to online travel sites - where individuals can compare prices as they shop for coverage. It aims to reduce the cost of insurance by enrolling younger (healthier) people into the insurance system. In addition, the law bans insurance companies from denying health coverage to people with pre-existing health conditions, allows young people to remain on their parents’ plans until 26 years of age, and expands the eligibility of the public health programme for the poor. It also requires companies with more than 50 full-time employees to offer mandatory health coverage. The law aims to eventually slow the growth of US healthcare spending, which is the highest in the world (as of 2013, excluding investment, health expenditure as a share of GDP was 16.4% for the US and an average of 9% for European countries).

Returning to the future of Obamacare, contrary to Clinton’s intention of strengthening and expanding Obamacare, in Trump’s plan for healthcare reform, he declares that he would repeal Obamacare since he deems it unconstitutional to oblige people to have a mandatory insurance. Trump’s vision also advocates [1] interstate sale of health insurance with a view to lower prices because of competition, [2] deducting health insurance premium payments from individuals’ tax returns similar to what businesses do and [3] price transparency from all healthcare providers, especially medics, clinics and hospitals. In tandem, Trump vehemently opposes the provision of healthcare to irregular immigrants, which he claims cost the US an annual $11 billion. The latter provision contrasts deeply with Clinton’s view since she seeks to expand access to affordable healthcare regardless of immigration status. Indeed, Clinton sponsored the Legal Immigrant Children’s Health Improvement Act of 2007.

Interestingly, both Clinton and Trump want government to negotiate with pharmaceutical companies to slash prices of medicines. This intention was heralded by the price hike of an old anti-parasitic drug Daraprim® (pyrimethamine). Although Daraprim® has beenoff-patent since the 1970s, following the acquisition of its marketing rights by Turing Pharmaceuticals in 2015, Turing increased the price from $13.50 to $750 per tablet. This was made possible because of the drug’s limited patient population, the absence of competing manufacturers, and a lack of therapeutic alternatives, effectively creating a monopoly. However, this turned the cost of prescription drugs into a political issue with health care analysts envisaging a catch 22 in the proposed governments’ intervention in pharmaceutical pricing … allowing the government to exert such influence could have unintended consequences, like suppressing drug company revenues which will inevitably cut back on research.

Notwithstanding the above, we are discussing politics after all, where candidates talk the talk but often, do not walk the walk. Despite all the confrontational drama with pharmaceutical companies, this industry continues to heavily finance candidates in their electoral run … to date, donating $7 million to presidential candidates in the 2016 presidential election, according to the Centre for Responsive Politics.

Highlights

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