For a rich nation, I suspect the US appears to observers from most Western nations to have an in-built desire to provide a health service which caters for everyone except the sick or those at serious risk from illness.

If I have understood it correctly, prior to the Obama administration, the powerful insurance companies had been developing a system whereby the health insurers had been encouraging healthy people with few health risks into taking out insurance.    The reasoning appeared to be that this was because they would thereby increase the profits of the insurance companies.   While this had been good for the shareholders, prior to Obamacare the figures showed the premiums for the seriously ill and those most at risk had been steadily rising.

For the last few years it did appear President Obama had managed to smuggle an Affordable Care Act past the interests of at least some of those who placed profit ahead of genuine care. The Affordable Care Act in its simplest form put the sick and poor in the same pool as the healthy and wealthy – which meant the rich healthy would now be providing the subsidy safeguard for those who were most vulnerable.

It also occurs to me that even Obamacare was second best because many other nations circumvent most of the unfortunate side effects of an insurance driven  health system by providing a good proportion of the health costs from taxation.  This might well be why in nations such as my own, there are proportionately far fewer in the population depending on health insurance in the first place.

It is not at all clear that President Trump is served by advisors who are themselves informed on health care reform.   The most striking example of embarrassing ignorance was when after the recent visit of the Australian Prime Minister the President announced that the Australians had a better health system than the US.    The Australian health care system which provides heavily subsidized and almost universal coverage for its citizens just happens to be virtually the opposite of what the GOP health care proponents and Trump himself have been advocating over recent weeks.

While it is relatively easy to find advantages in the Australian system in terms of cover provided it also involves a substantial contribution from their taxation system to fund the system. This most certainly would not support the current Trump initiative to reduce taxation. That the GOP advisors have missed this obvious fact for the last seven years would not reflect well on their preparation for the current health care reform, and Bernie Sanders has seized upon the last minute change of Trump announced support for a totally different system.   Sanders is now promising to make sure the Senate is clear that Trump himself prefers an opposite scheme to the one he claims to support.

Now President Trump is officially still on course to get back to a scheme whereby a good percentage of the core supporters of the GOP (which just incidentally happens to favours the rich and healthy) would be insured separately from the pool of those at genuine risk of health issues. Because the sick and vulnerable ones would then need to be in a pool financed by their own contributions and because this is clearly much more expensive than the demands of the pool of healthy citizens, the net result is that for the pool of the health risk contributors to be able to provide sufficient funds to meet most of the health costs, their premiums would shoot up and be unaffordable for many.

By some curious jump of logic the Trump repeal version has the profits from the healthy and low risk pool providing the necessary subsidy backup – always assuming of course that shareholders and insurance company owners want to release the profits in this way!

This seems unlikely in the extreme since the impetus of the main present support for the Trump repeal comes from those who are stakeholders in the insurance schemes and therefore primarily concerned with profit. Mr Trump and his willing supporters seem oblivious to the fact that having everyone in the same pool as per the Obama Affordable Care Act would have already guaranteed that subsidy the GOP now hope will somehow eventually appear in the Trump version.  In any case, if profits from the  healthy group are transferred to the needy group sufficiently to reduce premiums to the present rates, then the repeal achieves nothing apart from an extra layer of bureaucracy which some cynics might not see as draining the swamp.

Instituting such a scheme at the same time as tax reductions would apparently remove any possibility of the Government stepping in to rescue any disadvantaged by the Trump scheme, some might think is a little unwise!

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