As of 2024. should the Affordable Care Act be judged a success or a failure and why?
I have trouble coming up with a decent analogy that describes the situation with the ACA and the U.S. healthcare system. The system is so bad and yet the fix, though not simple, is obvious. U.S. health care and the ACA fix is kind of like the patient walks into the E.R. with a life threatening bullet wound, the bullet is lodged close to the patientu2019s heart but, for some reason, the doctors only put a bandage, the ACA, over the entry hole and send the shooting victim home without surgery. What was really needed was heart surgery to remove the bullet however some of the doctors think that even the bandage is more treatment than the patient needs, so the compromise was nothing more than a bandaid and the patient, the U.S. healthcare system is now dying.There are a lot of people lying about what is going on with U.S. healthcare. We are told that the ACA is some kind of socialist program designed to ruin a perfectly good free market based system of healthcare. On the other hand, others are saying that the ACA band aid is somehow going to fix one of the worst health care systems in the developed world. (U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries - Forbes).The U.S. healthcare system is a uniquely twisted American approach to providing a service via middlemen and the politicianu2019s response to those who say it needs improvement is a microcosm of the problem of the poor political leadership of the U.S. The ACA is trying to fix something that cannot be fixed. The ACA never had a chance of success.There is No Profit Motive to PrGood Service to the PatientLetu2019s put to rest the B.S. that the U.S. healthcare system is some kind of capitalist free market system serving patients. Under the existing system of U.S. healthcare, regardless of ACA or no ACA, a patient that walks into a doctoru2019s office is most likely not the paying customer. The paying customer for healthcare is most likely either an insurance company or the government but almost never the person receiving the service. In other words, the paying customer for healthcare in almost every case is a middleman, whether it is Humana, or Aetna, or Medicare or whatever. The middlemen customeru2019s demand determine costs and services provided. The patient is nothing more than a transaction. No wonder U.S. healthcare is so bad.A patient walks into the doctoru2019s office or a hospital and the very first piece of information that the patient provides, sometimes even before what is wrong with them or what hurts, is health insurance information. Why is that? Why does the doctor want to know what health insurance you have before they treat you? The doctor needs to know who the paying customer is so he or she will know what treatments will be paid for. The patient is not the customer, the tail is wagging the dog.For example, personally for a long time I needed a drug called LIPITOR to fix my genetic high cholesterol problem, but my doctor didnu2019t bother to prescribe it or even tell me about it because he knew my insurance would not pay for it and no way could I afford it. Instead he prescribed Simvastatin which is the generic ZOCOR and drug that only marginally addressed my condition. Finally after 3 years of additional damage to my pulmonary system, Atorvastatin, a generic for LIPITOR came out, but it would be another year before the generic was cheap enough so that I got what I needed and only after Pfizer made $130 billion over charging for the drug.Why the ACA is Nothing More than a Bandaid over a Bullet HoleBefore the advent of the ACA, a very high number of Americans did not have healthcare insurance. Either the insurance was too expensive, there was no employer to prit, or the patient had a preexisting condition that the insurance companies would not cover. One symptom of this problem is the scandalously high infant mortality rate in the U.S. Basically, impoverished women are having babies without the services of a obstetrician because they cannot pay for it. The ACA set about trying to fix the access to healthcare through the current private and government insurance system. By making healthcare insurance mandatory, the ACA attempts to change the statistics of healthcare allowing insurance companies to accept higher insurance risks and insure pre-existing conditions without losing money. Thus, theoretically, more people are insured. In cases where patients simply cannot afford health insurance, the ACA has the government step in to subsidize insurance. The ACA does not attempt to improve the quality of the U.S. healthcare system. If you had a choice of where to break your leg and receive care for it then you are better off breaking it in Cuba and going to the hospital there, than the U.S. ACA or no ACA, you will almost alway be more likely to have a better outcome for the most common injuries and illnesses in another country. Also the ACA does not lower the incredibly high cost per patient in the U.S. which is double the amount spent by countries known to have the best healthcare in the world.The Health Insurance Companies Make Everything WorseAll insurance companies, doesnu2019t matter what kind, make their profits through something called float. Everything else, the administrative overhead and claim payments are a wash verses premium payments from clients. Float is simply the interest earned on the money while it sits in the insurance companyu2019s bank account before it is paid out to claims.For an insurance company, managing float, i.e., lengthening the amount of time that money spends in the companyu2019s bank account, is everything. Even lengthening the float a few hours can make a huge difference in the profitability of an insurance company. While this business model may be OK for car or life insurance, having the management of float determine what treatments a patient will get is just nutty, but that is basically what is going on.The middleman is a U.S. phenomenon. We buy our cars from a dealer and it is illegal in many states to sell cars without the dealer middleman. We buy our cell phones from a network instead of directly from Apple or Samsung because the AT&T or Verizon middlemen have manipulated the politicians and FCC to create a system that forces us to into a technology that is more primitive than in countries like South Korea. So it is no surprise here in the U.S. that actuaries instead decide what health care is available and at what cost.Remember the float is what counts. The more money floating in the bank account the better. The insurance companies are not motivated to reduce the cost of healthcare. Quite the opposite actually. The more money things cost the better it is for them. As long as the actuarial tables predict the costs accurately, insurance companies will gladly pay.The Political System Does Not Serve the PeopleYou think these idiots in Congress do not understand the problem? Think again, insurance companies, mostly health insurance companies have donated $15 million to politicians during the current election cycle. That is only the part that we know about and does not include PAC money. Any solution that Congress comes up with is going to have insurance companies involved, guaranteed by our corrupt political system. We either going to have the extremely poor pre-ACA health care system or something with a bandaid like the ACA.A Modest ProposalSpain and Italy do not have the best healthcare systems in Europe. Yet, they are miles, miles better than the U.S. system and at 1/3 the cost per patient, with better service, more and better doctors, nurses, and hospital beds per capita and there has been less than 1% inflation of per-patient costs for a decade in those countries (What Makes Spain's Health Care System The Best?). We should emulate them. Imagine your health insurance premium at 1/3 what it is now and not inflating. Walk into any doctor, no fees, maybe they ask you your name and lookup your healthcare history, that is all. The only difference is that you write that check to the government not an insurance company.The barriers to this solution are getting past the political marketing financed by the insurance companies. The people must for an end to political corruption and forcing the U.S. political system back to serving the people instead of serving the corporations. Basically, we have one group of politicians working together to make the U.S. government fail where other governments succeed brilliantly, while the other group of politicians sit idly by like so many sheep as wolves tear apart one of their number and watch it happen. The American people are SOL as long as that is going on.
