Comparative Study of Obamacare and Trumpcare: From the Perspective of Liberal International Order

Abstract

Different from most studies that focus on the external shocks to the Liberal International Order, this research discusses the domestic identity of the order. Drawing on the experience of the U.S. healthcare system from Obamacare to Trumpcare, this study critically analyses urgent priorities, key provisions, policy effects, and social responses, and further discusses the structural dilemmas of the U.S. social welfare reflected. By expanding health insurance coverage through administrative means, prohibiting price discrimination and background checks of insurers, and establishing a “value-based” healthcare payment system, Obamacare has increased the U.S. health insurance to unprecedented coverage, especially for low-income groups, but at the expense of increasingly heavy federal burden and expensive per capita spending, resulting in a counter-productive effect of “health care tax” as well as triggering criticism for undermining the free market and resentment from the middle class and beyond. In contrast, Trumpcare may be able to curb rising federal healthcare spending in the short term, protect the interests of specific interest groups, and demonstrate a return to the free market. Essentially, however, its abandonment of low-income groups, the elderly, and other disadvantaged groups, alongside its institutionalization of inequality, embodies precisely the endogenous self-collapse gene of the Liberal International Order. In the long run, Trump’s system tends to create more damaged people and further exacerbate the tear in American society, thus weakening the domestic identity of the Liberal International Order and shaking its political foundations.