The large field of Democratic presidential hopefuls recently participated in a couple of policy debates, with healthcare again taking the forefront of the issues debated.  

On one side, candidates were proposing a Medicare for All program that will in essence replace the current healthcare system. Senators Bernie Sanders and Elizabeth Warren spearheaded the idea with support from many others in the crowded field.  Medicare for All will change the way Americans are covered today, shifting more control of healthcare to the federal government and essentially eliminating the private insurance industry. The plan will have Americans enrolled in a national health insurance program comparable to what other developed countries have implemented. Funding for this plan will require additional taxes in order to expand the current Medicare system and make it available to all Americans.

On the other side, candidates such as former vice president Joseph R. Biden Jr. and Gov. Jay Inslee proposed a public option program, which is another government-backed insurance program that many see as a bridge towards a Medicare for All overhaul. While a public option may take several forms, some of the candidates have stated that such a plan will be an addition to the Insurance Exchanges created by the Affordable Care Act. Conceptually, a public option would be more affordable because the government will use its negotiating powers to gain lower rates with physicians, hospitals and pharmaceuticals in an aim to reduce costs.

One would ask as to why healthcare is again at the front of policy debates since the ACA recently overhauled the entire system. The United States spends more than $3.5 trillion in healthcare, or $10,739 on a per capita basis, which is an incredibly large number for many to understand or compare. To put it in perspective, the U.S. healthcare expenditures are as large as the fifth largest economy in the world. These large numbers make our healthcare system a focus of any political policy debate, especially since many argue that the system does not deliver better outcomes than those of countries spending half or less on a per capita basis. Coincidentally, the ACA has a new challenge that has been recently heard by the fifth court of appeals, and a ruling on its constitutionality is expected soon. The details of the above proposals are still blurred, but certainly healthcare will continue to be a significant part of the presidential debates, unless it is derailed by the recent gun control debate or a significant change in the economy. It is somewhat premature to know in which direction the country will vote or whether any of the healthcare proposals will become a reality, but our Guam leaders need to be actively engaged and monitor any possible changes to ensure that Guam is included in the positive applications of the proposed policies.  The U.S. territories were excluded from some parts of the ACA that would have benefited our island residents greatly.  

While the public policy debate will continue during the rest of the presidential campaign, there are private efforts to contain healthcare cost through consolidation. Recently, we have seen vertical integrations with CVS-Health/Aetna and CIGNA/Express Scripts completing their respective mergers in December 2018, after extensive reviews by the Federal Trade Commission and the U.S. Department of Justice.

Adding to this trend is the arrival of Silicon Valley companies and start-ups that are seeking to disrupt the healthcare system. Companies such as Amazon, Apple, Google, Microsoft and others have invested heavily and established footholds that will disrupt the existing system by implementing new and efficient applications.  Some argue that doctors Alexa and Siri will be a part of many Americans households in the near future.

As the democratic field narrows down, the republicans will also start offering their healthcare policy options as part of the re-election campaign for President Trump.  We will be closely monitoring the healthcare policy debates and will provide analysis as the presidential campaign continues to unfold and the details of the proposals become clearer. mbj


— Frank J. Campillo is the health plan administrator for Calvo’s SelectCare and holds the managed healthcare professional designation. He can be reached at [email protected]