......The Affordable Care Act, better known as Obamacare. Now, before you shoot daggers at me, I will add that the system we had before Obamacare was a dismal failure, too. Sick people were denied coverage. Life-saving tests were unaffordable for many. Insurance companies could decide a treatment was not warranted and people would die. Those without employer-provided policies who didn't have any dreaded "pre-existing conditions" faced back-breaking premiums, deductibles, and limitations. Bankruptcies happened.
So, where are we? The unfettered for-profit system prior to 2010 was a train wreck. The ACA is headed to a future where premiums are too expensive to pay because competition has disappeared. Health care companies have figured out they are better off walking away from customers if they are too sick. The fines for not have health coverage are so low that many younger people are better off paying the penalty rather than hundreds of dollars a month for coverage with huge deductibles and a tiny network of providers. Some states have only one company in their health exchange. That is a guarantee for failure.
Some will argue the answer is obvious: make Medicare an option for everyone. The system works. There is fraud, sure, but there is fraud in the private model, too. There is fraud in Social Security but I've never met anyone who wants that essential service terminated. Heavens, there are billions of dollars of waste and fraud in the Pentagon, but we must have a defense system.
With tens of millions of additional customers and no more need for subsidies, the government could afford to increase what is paid to providers. Drug price negotiation would become standard practice. Medicare has few exclusions and even fewer limits on coverage. Those who need it could get it.
I think there would still have to be some form of private option. We are just too independent and fearful of total government control to make Medicare the only health insurer. The insurance companies would be happier because the healthier people would probably choose a private company, allowing for lower premiums and a decent share of the market. Medicare Advantage programs and Medigap policies would still be available.
Obamacare was pushed through a very reluctant Congress. The law was massive, poorly written, and based on conclusions that have not come true. As structured it will not survive much longer. But, if it collapses do all the people who were unable to get insurance before, or excluded from life-saving procedures, get tossed under the bus again?
Like a few other hot button topics in today's America, health care remains a subject whose mere mention can trigger more heat than light. I really hesitated to write this post for fear of a tsunami of "I told you so" or "this political party or that does or does not have any answers."
The point of this post is actually more of admitting that changing one's opinion about something important can be admitted publicly. Humans change their minds and change their opinions on a regular basis. But, I am convinced that too often we refuse to admit those changes for fear of what others may say and think.
So, I am putting myself on the line here by saying I have changed my mind about the Affordable Care Act's ability to solve our healthcare problems.
I trust you to not throw me to the wolves.
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