President-elect Donald Trump has consistently called to repeal or replace the Affordable Care Act throughout his campaign, but many pundits see this as being a catch-22 for the incoming administration. America’s healthcare system is already a global outlier (in a bad way), with disproportionate amounts of money being spent for very little return on life expectancy. For that reason, many people see the additional coverage of 20 million new people through Obamacare as a crucial step forward. However, this new coverage hasn’t come without major challenges. Obamacare is plagued by soaring premiums, insurers leaving the program, and coverage monopolies in certain states. This puts America’s healthcare at an inflection point, and no one really seems to know how to solve it.
The Obamacare Dilemma
The following infographic from Healthgrad sums up the most recent metrics on Obamacare, as well as showing the double and triple digit rises in premiums that some states are facing.
As the infographic notes, the cost of healthcare has continued to escalate year after year, outpacing both inflation and wage growth. Obamacare has not been immune from this trend, and premiums are now being hiked because of low enrollment, mispriced plans, a dwindling pool of insurers, decreased competition in exchanges, and sicker patients than expected. Despite only 25% of Americans supporting the outright repeal of Obamacare, it’s looking more and more likely that the healthcare system of tomorrow won’t look quite like it does today.
The Post-Obamacare Era
Right now, nobody knows quite what the future holds for U.S. healthcare. Repealing or replacing Obamacare is fraught with at least six major issues, but perhaps the most significant one is a lack of decisiveness within the Republican party itself. What would Obamacare be replaced with, and how would that change be implemented? Interestingly, there are at least seven Republican plans that have been tabled to replace Obamacare. Within that group, two of the more prominent ones come from Georgia Rep. Tom Price and House Speaker Paul Ryan. Tom Price, who is Trump’s pick as the incoming secretary for the Department of Health and Human Services (HHS), has already published his consumer-driven healthcare model, and it already exists in legal language. In additional, Paul Ryan released his own proposal in the form of the A Better Way plan earlier this year, which also touches on other issues such as poverty, national security, and the economy. Despite the number of options, the problem is that no one can agree on a particular solution. The party is heavily divided, and Trump is already receiving heavy blowback from the Tea Party faction for telegraphing potential delays in repealing or replacing the act. Yes, the future of U.S. healthcare is murky – even to Trump and the GOP. However, what is clear is that with most chips stacked in the Republicans favor over the coming years, it is unlikely that they will miss the opportunity to initiate the post-Obamacare era in some shape or form.
on Even while political regimes across these countries have changed over time, they’ve largely followed a few different types of governance. Today, every country can ultimately be classified into just nine broad forms of government systems. This map by Truman Du uses information from Wikipedia to map the government systems that rule the world today.
Countries By Type of Government
It’s important to note that this map charts government systems according to each country’s legal framework. Many countries have constitutions stating their de jure or legally recognized system of government, but their de facto or realized form of governance may be quite different. Here is a list of the stated government system of UN member states and observers as of January 2023: Let’s take a closer look at some of these systems.
Monarchies
Brought back into the spotlight after the death of Queen Elizabeth II of England in September 2022, this form of government has a single ruler. They carry titles from king and queen to sultan or emperor, and their government systems can be further divided into three modern types: constitutional, semi-constitutional, and absolute. A constitutional monarchy sees the monarch act as head of state within the parameters of a constitution, giving them little to no real power. For example, King Charles III is the head of 15 Commonwealth nations including Canada and Australia. However, each has their own head of government. On the other hand, a semi-constitutional monarchy lets the monarch or ruling royal family retain substantial political powers, as is the case in Jordan and Morocco. However, their monarchs still rule the country according to a democratic constitution and in concert with other institutions. Finally, an absolute monarchy is most like the monarchies of old, where the ruler has full power over governance, with modern examples including Saudi Arabia and Vatican City.
Republics
Unlike monarchies, the people hold the power in a republic government system, directly electing representatives to form government. Again, there are multiple types of modern republic governments: presidential, semi-presidential, and parliamentary. The presidential republic could be considered a direct progression from monarchies. This system has a strong and independent chief executive with extensive powers when it comes to domestic affairs and foreign policy. An example of this is the United States, where the President is both the head of state and the head of government. In a semi-presidential republic, the president is the head of state and has some executive powers that are independent of the legislature. However, the prime minister (or chancellor or equivalent title) is the head of government, responsible to the legislature along with the cabinet. Russia is a classic example of this type of government. The last type of republic system is parliamentary. In this system, the president is a figurehead, while the head of government holds real power and is validated by and accountable to the parliament. This type of system can be seen in Germany, Italy, and India and is akin to constitutional monarchies. It’s also important to point out that some parliamentary republic systems operate slightly differently. For example in South Africa, the president is both the head of state and government, but is elected directly by the legislature. This leaves them (and their ministries) potentially subject to parliamentary confidence.
One-Party State
Many of the systems above involve multiple political parties vying to rule and govern their respective countries. In a one-party state, also called a single-party state or single-party system, only one political party has the right to form government. All other political parties are either outlawed or only allowed limited participation in elections. In this system, a country’s head of state and head of government can be executive or ceremonial but political power is constitutionally linked to a single political movement. China is the most well-known example of this government system, with the General Secretary of the Communist Party of China ruling as the de facto leader since 1989.
Provisional
The final form of government is a provisional government formed as an interim or transitional government. In this system, an emergency governmental body is created to manage political transitions after the collapse of a government, or when a new state is formed. Often these evolve into fully constitutionalized systems, but sometimes they hold power for longer than expected. Some examples of countries that are considered provisional include Libya, Burkina Faso, and Chad.
