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by cujo
4459 days ago
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I agree that the ACA needs work, and has some questionable elements. The conflict I have is that I see as so much better than the previous non-system that it's hard to argue about it's crappy parts without someone jumping on the NObama train and killing any chance of discourse. |
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There are a variety of problems with medical coverage in the United States, in large part, because most of our medical coverage is handled by insurance. Insurance, at its core, is not good at complete coverage, and if we expect it to be, it's always going to be more and more expensive, especially as the payer is abstracted away from the true cost.
Medical insurance arose as a response to the wage freezes enacted by the government during the war. Wages were frozen to 'stabilize' the economy and money could be dedicated to fighting the war. The unintended consequence here was that businesses, leveraging 'benefits' to compete for top talent, petitioned the IRS to allow for medical coverage to be pre-taxable income. The result is that we have a system where largely, other people are footing the bill for medical costs. This was, IMO, the genesis of our failing health care system.
This got worse and worse and worse until the ACA. Now, the ACA appears to be fixing the problem with more of the same. More people abstracted further away from the actual cost of health care.
(Again, IMO) this is not a long-term fix, and I'll be very surprised if we don't see rates escalating dramatically in the next few years.
Before insurance became pervasive, insurance was for catastrophic purposes. E.g., cancer. For general health care needs, the flu, a cold, a pulled muscle, a broken wrist, etc., people should be paying for their medical expenses out of pocket, while paying into their insurance to buffer against bankruptcy from something like cancer, leukemia, etc.
If that were the case, we'd see the free market work. People wouldn't get three X-rays and two MRIs to determine whether or not a wrist had a very minor fracture or a very major sprain -- they'd just slap a cast on it and wait a few weeks until it was better. That cast costs a small fraction of the cost of an X-ray, or an MRI... but because the insured don't generally pay those costs out of pocket, they get all the X-rays that are needed, because they're free -- and then they're surprised at the cost of health care.
I have objections to the ACA on grounds of politics, and I have concerns with the ACA on grounds of pragmatism. I certainly don't begrudge those who have needed insurance but didn't have it until now, but if we really want to lower the cost of routine health care coverage, I find the current approach to be the least likely way to address it, and foresee rising health care costs in the future.
Again, just an opinion (though I think it's informed), and I could be proven completely wrong in a few years.