Next up for discussion by the Cafe Society on Feb. 7 will be the growing number of health-related issues that President Trump will have to deal with early in his Administration. He will have to make good on his promise to eliminate the Affordable Care Act and come up with something better.

The troubling word will be “affordable” since best indications are that it will take considerable time and additional legislation to eliminate all vestiges of “Obama Care” and replace it with something more to the liking of the Republican Party. There may be in effect bits and pieces of two overlapping health care insurance programs in play at the same time since an estimated 20 million people will expect similar or preferably better health coverage now that they the have had a taste of it. Even with control of the Congress, it won’t be a neat surgical process. Since the all-abiding axiom of the medical profession is to “first do no harm,” it may be difficult to live up to expectations. Important as it is, this and other health related concerns may have to be put on a back burner while critical housekeeping issues (like the Federal Budget, national security, taxation, immigration, and trade policies) are resolved. But the reprieve will be short lived.

Medical issues are an overwhelming component of state, federal and local governance. These informal discussions are held from 8:30 to 10 a.m. each Tuesday morning in the Rumsey Room of the Shepherd University (SU) Student Center. They are an integral part of the SU Life Long Learning Program and are intended to facilitate a dialog on current issues between the students and older members of our community. There are no fees or registration requirements.

Cafe Society facilitator, Mike Austin commented, “The health or general medical sector of our economy is huge and growing disproportionately. In recent years it has provided a significant number of new jobs and economic growth. While the economy was struggling to hang on to an anemic 1.9 percent of growth in the past year, the health sector grew by over 8 percent.

:The U.S. per capita expenditures for healthcare are more than twice the average of other developed countries — $9,024 in the U.S. compared to $3,971 for the U.K. for example, and $4,506 for Canada. When we deal with most aspects of health care, we run into that ugly word “expectations” again. As a nation, we seem to have a very low pain threshold. The British colloquial expression ‘What can’t be cured, must be endured’ is seldom, if ever heard here. As a nation we are over-medicated and constantly demand pills, nostrums, therapy, complicated surgical interventions, and a vast array of psychological and physical rehabilitation. In an aging society in which ‘Baby Boomers’ abound, ‘doctoring” tends to be the primary social activity.

“It can be very expensive entertainment. To make matters worse, these commodities and services are proffered in our free market economy in a manner that leaves the consumer few options. Who would think of comparison shopping to see who (which doctor, hospital, drug, or other medical service provider) offers the most value for money. We get estimates for a $4,000 job to repair our car, but wouldn’t think of asking one from our doctor for a $60,000 medical problem. If we did get a second opinion, which is normally not convenient, we would do so to consider alternative outcomes, but usually not costs. The general fix for that dilemma is …’that’s the insurance company’s problem’. Aye, there’s the rub! Maybe that’s a big part of what’s wrong. Insurance, government or otherwise is first and foremost a business. It is driven by numbers, balance sheets, computation of net gain or loss, governed by statistics (alternative facts par excellence) and algorithms. And unfortunately when you start injecting external parameters like: not considering pre-existing medical conditions, decidedly unhealthy life styles and drug dependency you really aren’t dealing with insurance, or for than matter, good medicine.”

Austin concluded by saying, “And if all of that isn’t complicated enough for President Trump and the Congress: in this great country disparities (as reflected in the insurance coverage that you may or may not enjoy are determined by a variety of factors such as where you work, if you work, how much you make and what you are entitled to.

So 49 percent of us are covered by our employer, 7 percent by non employer groups, 20 percent by Medicaid, 14 percent by Medicare, 2 percent by other public programs, and 9 percent are still uninsured.

There are many other areas such as the big pharmaceutical companies, the huge number of corporate players running hospitals, labs and research centers, proving nursing homes and assisted living facilities (including those for veterans), and the huge bureaucracy needed to handle the interface between doctors and patients. That is what we will be discussing next Tuesday.