On the inverse, I see many people on the left pointing to the number of people who have signed up as the primary indication of it's success as well. Which contains it's own notes of ignorance.
Was the government not handing out fines to people who didn't sign-up? So they were basically forcing people onto the program? How could the numbers of sign-ups be meaningful then?
Also, I couldn't imagine going without health care. You have to take what you can get otherwise the risks are significant. So considering it's an essential service, saying "look at the number of people using it" as an success indicator is like saying "plenty of people are calling the firemen, clearly they are doing a good job".
There is a serious human cost here when people have their health plans doubling in cost... while the rest of the world has worked out far more functional systems. So those cost calculations should be relative to this high level reality, not some internal benchmarks between stages of mediocrity.
It seems by not deciding to be free market nor socialized that the US is getting the worst of both worlds. It's easy to blame the republicans for this but the half baked socialized system that the democrats put forward was hardly a good solution.
> Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise
Have you considered that maybe the entire Democrat plan of getting to a socialized system via cuts and slivers in one direction, knowing full well that cuts and slivers will be done in the other direction is a terrible idea?
Stop pretending that private companies can function efficiently in an ever more legislated environment, as if only more thousand page bills get passed that it will finally start working well... history has continued to indicate otherwise. Either a) embrace markets or b) go hard on selling the public on the idea of single payer public insurance.
(I should note I'm in favour of public health insurance after living with it in Canada, despite typically being in favour of markets elsewhere)
If you do want my personal opinion, I'll give it here:
1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power.
2. From a free market standpoint, the current model of tying healthcare coverage to your employer hurts both employers and employees. As an employer, why am I responsible for paying this "benefit"? If too many of my employees get horribly ill, my premiums go up to the point that I can't provide a competitive benefit; my costs increase, my employees' contribution increases, and my ability to recruit talent suffers. As an employee, why must I forego an entrepreneurial opportunity because I can no longer afford healthcare for my children without an employer footing the majority of the bill?
3. From an efficiency standpoint, the current model wastes tremendous medical resources (bureaucracy, physician time, lack of cost transparency, treatment limits, etc.). I have friends in the medical industry (doctors, executives, med tech providers), all of whom dream of a single-payer system.
4. From a constitutional standpoint, I believe healthcare falls under "promote the general welfare" and "secure the blessings of liberty to ourselves and our posterity." A national, taxpayer-funded health program is no different than any number of other government-funded programs that free us to maximize our potential as citizens. And yes, we pay taxes to fund those services whether we use them or not.
So yes, I'm a believer in a single-payer model. Yes, I believe the ACA is essentially a handout to insurance companies. And yes, I was very disappointed when Obama took single payer "off the table."
However, I also think it's better than pre-ACA, despite its flaws. And at this point, it's certainly better than the chaos that will arise from simply abandoning it. Understanding its compromises, I can't really envision a "replacement ACA" that will pass a Republican congress that can be better.
If Congress delivers a better ACA, I'll happily embrace it. Heck, I'd even give credit to the Republicans if they just tweaked the ACA, renamed it "Winningest Solid Gold Trumpcare" and fully backed the result to make it successful. But I see no positive outcome if they go down the "repeal and delay" path.
The flaws of ACA are not inherent to a privatised system, they are the result of this specific implementation.
Like the U.S. military has maximum negotiating power with its contractors? I mean, who else is going to pay for the F-35?
Monopsonies aren't inherently more efficient than monopolies.
Do you truly feel military procurement is equivalent to healthcare delivery?
Have you ever sold products to the US government?
Do you believe the primary financial gains would come from negotiating power? (Hint, the list I provided is in order of impact.)
Are you familiar with the impact Medicare Part D had on prescription drug prices? (Spoiler alert: it "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients" [1].)
Do you believe the decisions behind funding defense are in any way influenced by non-economic factors? (Hint: defense budgets increase even when the military itself requests lower funding. Does government healthcare funding follow the same pattern? Why not?)
Are you familiar with the many estimates of the cost of a single payer program in the US? [2]
I could go on, but won't. This is not Reddit. Sound-bite caliber anecdotal arguments are a problem, not a solution.
[1] http://faculty.som.yale.edu/FionaScottMorton/documents/TheEf...
"Less efficient" is actually a nonsensical term to economists[0], but monopsonies are inherently inefficient, and it's rather straightforward to demonstrate that economically, the same way it's straightforward to demonstrate that a monopoly is always inefficient, even in cases of so-called "natural monopolies".
> Are you familiar with the impact Medicare Part D had on prescription drug prices? It "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients
You can't use Medicare Part D as an example of the impact that negotiating power would or would not have, because Medicare doesn't "negotiate" (read: unilaterally determine by fiat) the prices it pays for drugs, which it does do for providers.
> Are you familiar with the many estimates of the cost of a single payer program in the US? [2]
Yes, and most of those (including the ones you linked) are based on Medicare's reimbursements as a baseline. But that's totally baseless, because according to Medicare's own financial reports, they pay below-sustainable reimbursement rates to providers[1], which means that they are essentially subsidized by the premiums paid by privately insured patients. If Medicare were expanded to include everyone, they would have to massively increase their reimbursement rates, because the private insurance market wouldn't exist.
[0] Efficiency is best explained to a non-economist as a binary property; there does not exist a total (or even partial) ordering of inefficient states.
[1] They pay below COGS, which means that even if all doctors, nurses, and staff worked for free, they would still make a loss on Medicare patients in the aggregate, if they were not able to charge the difference to private insurers. Incidentally, that's why uninsured patients see such high bills - those are the prices that are used as a starting point when negotiating with insurers, and they're massively inflated to cover the gap.
Insurance companies did not know the health, and thereby the cost, of previously uninsured people buying coverage under ACA. To reduce risk of the unknown, the government committed to reimbursing money lost due to underestimating risk (conversely, insurance companies would pay into a pool if they earned above certain thresholds). Over time, prices would meet an equilibrium as policy costs stayed low, allowing more healthy people to join the pool, which lowers coverage costs, which then lowers policy costs. Prices could be raised modestly to account for the difference, and government payments to insurers would ultimately end.
However, Congress rejected payment into the risk pool and ultimately paid out only 12.6% of the promised funds. Many co-op insurance groups had to fold, others needed to dramatically increase premium costs to account for (a) the lost money, (b) the increased cost of the uninsured, and (c) the increased risk that the government wouldn't fulfill its obligations.[1]
The current situation - limited choices, high premium costs, and resultant lower healthy person participation potentially leading to a "death spiral" collapse - is a direct consequence of these actions, not an inherent failure of the ACA.
However, Obamacare gets the blame and Republicans can point to a failing market that they can repeal and, perhaps, replace. Very effective politics indeed. Just ignore the human cost, which certain politicians seem to have no trouble doing.
[1] https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-o...