A republican view of Obamacare.

Today Donald Trump’s campaign manager Kellyanne Conway said the President-elect is considering calling a “special session” of Congress on the day he’s sworn in to repeal President Barack Obama’s health care law.’ Why is the Affordable Health Care Act  ‘Obamacare’ so controversial?


Before Obamacare  fifty-eight percent of the population had insurance, mostly via their work but employers were not obliged to provide health insurance. Even if they were covered insurance companies may insist on exclusion clauses so pre-existing illnesses and some diseases were not covered. Those with long-term conditions sich as diabetes would find it difficult to get any insurance. Medicaid and Medicare are government schemes which cover the elderly and the very poor.  However this left a substantial number of poor and middle class Americans uncovered. Fifteen per cent  of Americans were  completely uninsured. Inability to pay health care bills was and still is by far the commonest cause of bankruptcy.Patients are routinely turned away from hospital if they cannot pay for treatments. Hence stories such as the series ‘Breaking Bad’  where a chemistry teacher starts producing drugs to pay for his cancer treatment which would of course be free in the UK.



Obamacare now covers 22 million Americans.  It forces all Americans to have health insurance, but offers subsidies to make coverage more affordable and aims to reduce the cost of insurance by bringing younger, healthier people into the  system. Only about 5% of Americans no longer have health insurance and pay the fines. Republicans have complained that it is an intrusion and people should have the right not to buy health care. It should be their choice not to spend money and take the risk.


It also requires businesses with more than 50 full-time employees to offer health insurance. This is a very significant cost to many businesses

The law creates state-run websites like online travel and shopping sites – where individuals can compare prices as they shop for coverage.

No one can be denied health coverage including those with pre-existing health conditions. It allows young people to remain on their parents’ plans until age 26 and expands eligibility for the government-run Medicaid health programme for the poor. It has also banned the practice of charging women more than men.


Why is Obamacare unpopular when it seems to have achieved so much? The answer is cost.The US spent $3.2 trillion in 2015, approximately $10,000 per person. The equivalent of over 3 months earnings after tax for the average citizen, more for a couple with a single earner. Although Obamacare subsides it a little, if you are suddenly made to pay that sort of sum when you had not bothered about insurance before it is bound to hurt.

The USA spends 20% of its GDP, $1 in every $5, spent in the USA is on heath care.This is three times as much of its  GDP as Britain which spends on average $2802 per person. Despite being the only developed nation without having universal coverage it has the worst health care statistics of all the developed nations according to WHO [the World Health Organisation and The Commonwealth Fund [a highly respected American Think Tank]. We in the UK have high life expectancy, despite spending far less.

According to the study carried out by The Commonwealth Fund , health care spending per person is highest in the U.S. not because Americans go to doctors and hospitals more often, but because of greater direct access to specialists and greater use of medical technology and health care prices that are higher than in other nations.

The wealthy in the US get too much medicine. For example  the last president – G.W. Bush was found as a result of routine screening to have a blocked coronary artery and opted to have a stent put in although stenting arteries in patients who have no symptoms  has not been shown to be beneficial and the proceedure is risky: it can cause heart attacks and strokes. “’This is really American medicine at its worst,’” said Steven Nissen, head of cardiology at the Cleveland Clinic in Ohio  . . .  ‘It’s one of the reasons we spend so much on health care and we don’t get a lot for it. In this circumstance, the stent doesn’t prolong life, it doesn’t prevent heart attacks and it’s hard to make a patient who has no symptoms feel better’”  The third commonest cause of death  was found be due to iatrogenic deaths [deaths as a result of medical intervention] in the USA.  The uninsured of course get no care and many cannot pay for the medicines.

All countries face enormous challenges with regard to health care. All developed countries have rapidly rising health care costs because of an ageing population, obesity and increasing technology. Enoch Powell, a former Health Secretary declared spending on health ‘a bottomless pit’ and indeed it can be.I am profoundly grateful to work for the NHS and have the NHS look after me if I get ill. It does have problems and faces major challenges and we should all strive to improve it. However like virtually all doctors, I am proud to work for the NHS and truly appreciate the fact that I never have to add to a patient’s distress by demanding payment!