The Affordable Care Act, or "Obamacare" as many people call it. It's a flawed law meant to put true healthcare reform in play. But the dysfunction of both political parties has locked in this law's provisions, the worst of them requiring people to buy unsubsidized insurance because their states didn't accept the medicaid expansion to cover these people.
One of the problems insurers have in America is that there is no price control on prescription drugs. The largest buyer of these drugs is Medicare, and yet, the federal government prohibits Medicare and Medicaid from negotiating prices for drugs. As a result, we have the highest costs for healthcare in the world. No wonder why many insurers are bailing out of the Obamacare health insurance markets.
Another problem is the inability to force the states to expand Medicaid, even with a 90% Federal government subsidy for those costs. Without nationwide participation, a law like this will fail, as people will blame the law for their problems and not the law makers who won't tweak the law to make it work for all. One might argue that this part of the law was a failure from the start. But in any law this complex, the drafters were likely to make errors. If we looked at law as we do for computer systems, we accept the fact that there will be computer bugs, and that they will be fixed. Why are many people condemning a law, when they should be condemning congress for not doing anything important in this area for generations, and then not fixing mistakes when they do something?
To me, an understated problem is the inability of insurers to get young adults to sign up for the higher levels of healthcare. The ACA depends on a large number of young workers (who are in good health) to pay into the insurance plans, so that older, less healthy, people can buy affordable insurance. Obamacare is a health care transfer from the young to the old, in the same way as Social Security is an income transfer program from the young to the old. In both cases, it only makes sense. In traditional societies, the young take care of the old. In an age of the sub-nuclear family, government mandated wealth and health transfers from young to the old make sense. Most people can no longer depend on their extended families for help.
There were many lies used to sell the public on the need for this law. This is not uncommon with politicians. FDR lied about keeping America neutral before WW2, even with the obvious signs that we could not avoid getting involved with this worldwide conflict. And yet, people accept the story given by their political tribes, instead of seeing the reality behind the scenes of the kabuki theater of politics.
Obamacare needs fixing. There are not enough insurers willing to participate in markets where they can't make money. There are not enough people covered by this law. There are not enough choices available to people in need. But let's not throw the baby out with the bathwater. If we get rid of Obamacare, we will return to a worse system than we have now. The only question is: Do we provide a "Public Option" or not? If there is a public option, the average person will likely pay roughly the same rate as state employees do for their insurance plans. (I use COBRA rates for my analysis.) Without a public option, people will go uninsured.
Are we heading towards single payer healthcare? Maybe. But if private industry wants to keep making profits, it will have to find a way of fixing a system that was broken way before the ACA was enacted, and will need to find a way to do it within the spirit of the ACA.
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