No matter what happens with health care reform, everyone won’t be happy.


And that’s where politics comes in.

There are a few facts about health care that are undeniable.

• First, the United States spends a lot more for health care than any other developed country. Driving down those costs will be difficult because one person’s waste is another’s profit.

• Second, the role of government is key. Democrats generally trust government to do the right thing. Republicans see bureaucracy, a lack of competition and waste.

• Third, Obamacare has created basically a new entitlement for about 20 million Americans, but this entitlement is based on shaky ground.

Robert Laszewski, a health insurance expert and consultant, has written that many insurers are losing money on the Affordable Care Act exchanges.

Small state plans that he is advising were losing more than $100 million last year, he said in a Vox interview.

Some of the major health insurers are pulling back or pulling out.

For instance, there is just one insurer in the Obamacare exchange in Oklahoma and Alaska.

That’s appalling.

For those Americans who don’t qualify for subsidies, the exchanges are not worth the premiums.

President-elect Donald Trump and House Speaker Paul Ryan have promised a quick replacement for Obamacare, because if they don’t, insurers will run for the exits.

Laszewski warns that the insurers themselves will have to be protected from losses, which Republicans are reluctant to do.

But politics will rear its ugly head in 2018 if the Republican replacement isn’t working.

A majority, 56 percent, told Rasmussen pollsters that Congress and the president should go through the Affordable Care Act piece by piece and improve it. That shows the public is more mature than many of the people in Washington.

Is Medicare the government?

Many Americans don’t view Medicare as an entitlement. That word sounds too much like welfare.

So what are the facts?

According to Urban Institute, a one-earner couple will pay in $70,000 in Medicare fees over a lifetime and receive $427,000 in benefits.

It’s a pretty sweet deal.

Cost is priority No. 1

Lowering the amount people pay for health care is the No. 1 priority of Americans, according to the latest Kaiser Health Tracking Poll.

In fact, about one-third of Americans have postponed checkups or medical procedures to save money in the last six months, reports the Rasmussen pollsters.

Most Democrats and independents prefer guaranteeing a certain level of health care coverage even if it means more federal spending.

Those working class whites who voted for Donald Trump are among those who still want their federally supported health care.

Focus groups conducted by the Kaiser Family Foundation provided insights as reported in The Washington Post.

“They were especially upset about surprise bills for services they believed were covered. They said their coverage was hopelessly complex,” said Kaiser head Drew Altman.

Some of the working class whites would rather have had Medicaid, which is viewed as simple and secure.

One man traveled to Eastern Europe to purchase insulin at 10 percent of the price he’d pay in the States.

Lifestyle impact on health

The best way to reduce health care spending is to practice healthy behaviors: exercise regularly, don’t smoke, limit sugar intake and fatty foods.

Chronic diseases like diabetes are huge drivers of health care spending.

Much of the chronic disease spending is preventable.

Rural America

People in the country are more likely to die from the top five causes of death, reports the Centers for Disease Control and Prevention in The Washington Post.

The five top causes of death in the U.S. are heart disease, cancer, accidental injury, chronic lower respiratory disease and stroke.

People who live in rural areas tend to be older, poorer and sicker, with higher rates of cigarette smoking, high blood pressure and obesity, the CDC reported.

Accidental injuries were 50 percent higher in rural areas due to car crashes and opioid overdoses.

Equally alarming is that health care is often lacking in rural areas. In too many of these communities, there is a shocking shortage of rescue units and trauma centers.