You asked my opinion, but I would have voiced it even had you not. You gave above what seems like a correct summery of where we stand today, or will stand once the Obamney care wrinkles get ironed out, assuming they do. And you wisely avoided further chaos by omitting mention of the several other disparate pieces of the American Medical care landscape.
Sadly, as most in this forum recognize, Obamney care, as it is now conceived, will not solve our fundamental problem of costs that will eventually bring our nation to its economic knees. The ACA has incorporated features that are projected to decrease the rate at which costs are increasing. One can argue that that is a step in the right direction, but it would be safer to say that it could be a step in the right direction. My personal view remains unchanged, however. This Obamney plan is seriously flawed, primarily for three reasons: 1. The 1945 McCarran Ferguson Act is left in place (this is fatal!); 2. It has no public option; 3. The Court has allowed States to opt out of Medicaid expansion. At best, the ACA won't take us very far down the road to achieving universal access to medical care at a reasonable cost.
Not everyone agrees that we should have universal access. A minority believe healthcare is not a fundamental right, and that if you can't afford it, you have no right to expect it. I emphatically disagree with those who think this way. As far as I'm concerned, no modern nation is truly civilized unless all its people have ready access to basic health care. And I want to live in a civilized nation. I will add, that even if those that do not accept access to healthcare as a fundamental right offer iron-clad, impeccable logic that supports their position, they will be personally better off in the long run to accept access as a desirable feature and work toward that end.
Apropos is a paraphrase of a comment that an economist friend of mine, J.H. Vogel, made in a recent paper,viz., a class of problems exist where technical solutions are known and go unimplemented. Logic and evidence do not prevail. Health care in the U.S.A. fits into this category. If experts continue to voice only technical solutions, the situation will worsen! The reason for continued dismissal of practical solutions is not for lack of exposure to them. It lies elsewhere.
What will result when we are confronted with an unimplemented, technical solution to a significant problem? At least initially, it will be a brokered compromise. That's where we are at present. If that brokered compromise is either a slight improvement, or not clearly worse, it will be adopted and we will progress toward an eventual crisis.
If you follow the history of American medicine, it will be clear how we arrived at the present chaos, i.e., step by step. It, therefore, may be unreasonable to expect a one step solution to our madness. But, of course, at least thirteen, one-step solutions do exist, one in each of our thirteen, industrialized, sister nations. And several more good ones also exist in emerging nations. So there is no dearth of good models to follow. That won't do as an excuse.
All the other industrialized nations have one healthcare system. We have none. What we have are jigsaw pieces: Single payer socialist (the VA), single payer hybrid (Medicaid); subsidized-self-funded, insurance-augmented (Medicare); Private, corporate funded, insured (employer group); Private, self-funded, insured; indirect-subsidized, piecemeal (emergency room). And we are in the process of attempting to replace the latter two pieces, with a new piece to the puzzle, viz., federally-specfied-state-controlled, subsidized, privately insured (Obamneycare). [I could easily have over simplified here!] Could anyone possibly envision a worse nightmare?
Good luck with all that, I say. We'll need it!
