The future of US healthcare: Haves vs. have nots
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While few would argue that the healthcare system as a for-profit business model is the U.S. is inherently dysfunctional, controversy still rages over how to pay for it. As a result, the majority of Americans are faced with uncertainty over their future and the future of their children. The new Trump Administration wants to repeal and replace the Affordable Care Act (ACA), but the people have not yet been made aware of what these changes will entail.

In a search for some hint as to what is going on behind the scenes, several leading experts in health policy were recently asked to give their predictions on what Americans can expect will happen in the next few years. Overall, some interesting trends are beginning to emerge that may at least help people prepare for what is coming soon.


Harvard health policy professor and director of the Harvard Global Health Institute, Ashish Jha, M.D., M.P.H., speculated about health policy reform despite the mixed messages he perceives as coming from the Trump administration, such as repealing the ACA while saying everyone must have health insurance. “The interesting issue in my mind is what happens to MACRA,” Jha explained.


MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. The ruling fundamentally changed the way that the U.S. evaluates and pays for Medicare and Medicaid services. Most people probably haven’t yet had a chance to read the nearly 2,400 page final rule published in November 2016. U.S. Rep. Tom Price, M.D., (R-Ga.), Trump’s candidate for secretary of the Department of Health and Human Services, has expressed serious concerns about the contents of MACRA.

Jha isn’t too concerned unless the new administration reforms MACRA. Otherwise, he said, “I don’t see any major reforms happening to either Medicare or Medicaid. I think a lot of Republican governors would not be happy about Medicaid block grants, and there’s going to be a lot of concern in Congress about whether this is politically worth doing.”

Twila Brase, R.N., who is the co-founder and president of the Citizens’ Council for Health Freedom (CCHF), has her attention on the ACA and foresees a full repeal. She warned that the ACA was really an effort “to impose socialized medicine on patients and doctors.” Long-held plans began when President Harry Truman proposed a “universal” national insurance system in 1945, made strides when Medicare and Medicaid were enacted in 1965, and were nearly realized when the ACA was enacted in 2010.

Brase stated that the ACA “has demonstrated the ugly side of socialized medicine: high costs, fewer choices, outsider control of doctors and less access to care.”

Perhaps the U.S. truly is moving toward socialized medicine. Another expert, Jonathan Gruber, Ph.D., is the former Deputy Assistant Secretary for Economic Policy at the Treasury Department and current professor of economics at the Massachusetts Institute of Technology who foresees universal healthcare coverage as inevitable. Since equal healthcare for all is “impossible and impractical,”

Gruber described a two-tier health system, in which a defined accepted minimum standard must be defined and covered. Out-of-pocket care or coverage beyond that minimum standard should not be restricted or subsidized, he claimed.

Medicine for all sounds great, but socialized medicine can be dangerous if it falls into the wrong hands. Would a two-tiered system consist of unlimited care for the “haves” and a minimum standard for the “have-nots?” Who, exactly, would have a voice in determining of what the minimum standard should consist? According to Rep. Chris Collins, (R-N.Y.), there is “no need to worry” because he and his group have made a “promise” to “make sure that Americans are not disadvantaged” as a result of their current negotiations, whatever those may be.

Besides, Collins assured, “There’s not going to be any changes in 2017. There’s not going to be any changes in 2018 … So we’re talking about new plans in 2019 or later …”

So, in summary, it appears we are heading for two-tiered socialized medicine in the U.S. by 2020. If that is the case, perhaps it is time for Americans to take better care of themselves starting now.

Dana Connolly, Ph.D., is a senior staff writer for Sovereign Health, a behavioral health treatment provider with locations throughout the United States. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. For more information and other inquiries about this article, contact the author at, visit us at, Facebook and LinkedIn, or follow us on Twitter.

The views of contributors are their own and are not the views of The Hill.