When I was 13, I slammed my thumb in the door of my mom’s blue Mini Cooper. In an effort to show her just how angry I was about our morning fight minutes before, my melodramatic middle-school self got out of the car and slammed the door closed, not realizing my left thumb was in the way. I ended up breaking a bone in my thumb and crying in front of everyone at the bus stop. But, in a few short hours I was leaving the hospital post-thumb surgery, my left hand wrapped in bright pink gauze and positioned with a metal splint.
I am lucky. No, I am privileged. Not only did I grow up with a doctor in the family, but a family where having health insurance was never a question. Physicals, checkups and prescriptions were normal occurrences. A broken bone? No problem. I was rushed to the hospital and fixed at once, expenses paid, no issue. More than that, the rest of my life was just as privileged. I lived in a good neighborhood, attended a well-funded public school, had access to healthy food and parents with steady upper middle-class incomes. My experience may be similar to your own, but for others, good health and good health care is a different story.
As President-elect Donald Trump begins to fill crucial positions for his cabinet, he has spared no time in giving us a glimpse at his administration. For many, it’s like sitting in a waiting room at the doctor’s office: You aren’t sure what the doctor is going to say, what he’s going to fix or whether he’ll be able to fix it at all (or in Trump’s case, try to fix it). It’s waiting to see what policies will come out of an unpredictable presidency and how they will shape Americans’ lives. And of all the vital policies at risk, the Affordable Care Act is one that will affect millions. A running mantra of Trump’s campaign was repealing Obamacare. However, several days after winning the election, Trump altered his position on repeal, instead stating he’d keep some provisions of Obamacare. The ACA has been a highlight of President Barack Obama’s career and while its full effects are still to be seen, the legislation has dramatically lowered the number of uninsured in the United States. Republicans have long been against Obamacare, and now they have higher hopes to repeal it once Trump is sworn in. Though as a Republican president, Trump has his party members to answer to, he also has to answer to those who voted for him and those two groups prove to be very different from each other.
For the millions of Americans whose well-being depends on accessible health care, the possibility of repealing Obamacare, or devoting less funding to improve quality of care, is life-changing. By reducing affordability, you reduce access. Health care then becomes a privilege, something that only a handful of people get. Yet, health is not a privilege. According to the World Health Organization it’s a human right. Health care is a provision of maintaining a human right.
As many have noted, the biggest irony in Trump’s odyssey to the White House is the populism he ran on. Appealing to working-class and lower-income citizens, he essentially received votes from those who benefit the most from Obamacare. The ACA’s centerpiece is to provide affordable insurance to all by requiring Americans to get insured and simultaneously reducing adverse selection, which drives up insurance costs. Obamacare especially targets those who may not get insured otherwise due to socioeconomic status and insufficient or expensive employee benefits. In addition, widespread health coverage is a way to reduce disparities in health. Those who cannot afford to be insured and thus maintain good health suffer economically. Health is not a mutually exclusive component in our lives. Your health affects economic, social and emotional well-being. Thus, good population health not only benefits the productivity of an individual but of the nation.
The irony of Trump continues. The segment of society that gains the most from affordable health care is also the group that voted for a man with plans and an expectation from his party to repeal it or at the minimum reduce it. The New York Times highlighted this political paradox in a story on a woman who voted for Trump and the next week went to sign up for another year of Obamacare.
We’re in the waiting room now. We don’t know what path Trump will take on health care. His change from campaign to office leaves too much uncertainty. But, with a Republican majority in Congress, and the recent nomination of Obamacare critic Tom Price to the Department of Health and Human Services, reform is on the horizon.
At this point, we have the lowest rate of uninsured Americans in the last 50 years. Obamacare has made enormous strides in making health care more of a right than a privilege. In a Reuters poll, Americans viewed health care as the most pressing issue to be addressed by the new presidency. Yet, health care is only one aspect in the greater issue of health. Health care is a means to solving health disparities and improving population health, but it is not the singular solution. The root cause of health disparities between Americans doesn’t come from a lack of health care, but rather the social, economic and cultural structures Americans live in every day.
When it comes to health policy, the United States is an anomaly. We spend more money than most other developed countries on health care, but still exhibit lower life expectancy and worsening health outcomes. It’s a paradox — a paradox of our own doing.
I don’t believe we can depend on the Trump administration to approach health policy in a new way by putting more money into social services. However, these social roots of health disparities, lack of education and, most importantly, inequality in economic stability and employment, are problems that have been experienced by many of his supporters. Therefore, Trump could benefit from taking an alternate approach to health policy and working to mend the social factors that lead to health inequity by making good health a right and not a privilege for those millions who voted for him.
Anu Roy-Chaudhury can be reached at anuroy@umich.edu.