I am not a healthcare expert, though I was the Marketing Manager of the American Hospital Association for many years. It was a time before the corporate mentality was adopted by healthcare providers. A time before the thought of a socialized medical system for all was in anyone’s purview.

There was Medicare/Medicaid, but no one framed them as socialized medicine of any kind. These programs still provide care to those in need; Medicare to our elder population, Medicaid to the financially disadvantaged. Most agree, even with the inevitable abuses by some; they are successful programs. But, they didn’t start out that way. When implemented, our Congress did what it is supposed to do. They had varying opinions on how to “fix” the systems as problems arose, many very heated debates on how to fine-tune them and, in the end, came to consensus. Through the years, several changes have been made. The crux of what makes them fiscally viable (though a tweak is needed once again) is that contribution is mandatory through our tax system.

We now have the Affordable Care Act (ObamaCare) and the proposed American Health Care Act (TrumpCare) making us look at not only the future of Medicare/Medicaid but our entire healthcare delivery system.

Which of the two is the best for the most people? Complicated and important — not easily reconciled.

But, I think the basic fiscal principles of the two systems are pretty easily explained. Their success hinges on the 25-55-year-old “buying into the system.”

ObamaCare is socialistic; everyone must buy in or pay a penalty. TrumpCare is capitalistic, having no such requirement for that age group. Instead it relies on insurance providers to make their products so appealing, the 25-55 year-old demographic will see the benefit of buying in. The problem I see with this is relying on the insurance industry to craft incentives for young adults to shell out money voluntarily for insurance they think (if they think about insurance at all) they will not need for several decades. Call me crazy, but I haven’t had the greatest luck with health insurance providers.

I heard the “Health Secretaries” from both the Obama Administration and the Trump Administration speak about their respective programs and the differences between the two. Kathleen Sebelius recognizes, as I think most Democrats agree; ObamaCare needs some revising. Tom Price asks that we implement TrumpCare now and many of the concerns being raised will be addressed in Part 2 and 3 of the roll out; not yet ready for presentation.

No one has that magic crystal ball, not even the CBO whose report this week has spawned most of the discussions. That sticky number of younger participants just isn’t knowable and, without it, the projections of many of the other variables become iffy at best.

To me, the sensible road ahead is to revise the system in place — keeping the mandated participation and the benefits people like. As many are saying, let’s not throw the baby out with the bathwater.

Wendy J. Levenfeld is a published novelist, playwright and columnist. Send comments to wendylevenfeld@gmail.com. Visit Wendy’s website at www.wendylevenfeld.com.


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