The national political debate on healthcare has a singular focus on coverage for the uninsured. An emphasis only on coverage of those without insurance implies that we must spend more money to provide them with access to healthcare services.
We spend twice as much per capita on healthcare than the other economically advanced countries. This per capita calculation considers insured persons and all uninsured persons whether they are citizens or not.
Obamacare extended coverage for 11M people under an expanded Medicaid program without addressing healthcare cost levels. Obamacare established no way to pay for this expansion.
The Republicans fell into the Democratic trap set for them, proposing to cut coverage, principally on newly Medicaid insured persons. They, too, have failed to deal with the underlying healthcare cost drivers.
President Trump could fundamentally change the nature of the dialogue regarding healthcare. He could make a declaration that we have sufficient money already dedicated to healthcare to care for everyone. He could then challenge Congress to address the fundamental drivers of cost; a fee for service system which results in over utilization of tests and treatment, over specialization of our medical community, demand which is driven by 35% of our citizens being obese, demand driven by 10% of the population having the disease of addiction and the unnecessary costs that result from hyper-regulation of the industry.
It does not require that much thought to recognize that solving healthcare is about cost not coverage. You can only draw two conclusions from the current healthcare debate. Congress has either invested too little in understanding the healthcare problem or the Democrats and Republicans are choosing to fight over the issues of coverage because it is the most divisive political framework on which to focus.