I think both sides (defined for simplicity as left and right) have start by agreeing on objectives.
Re original topic of ACA, some objectives are to provide access to healthcare and find a "better" way to pay for it than the method before ACA. Remember that before, those without coverage (and for the most part money) got health care through the ER, free clinics, buying lower priced services as needed or by doing without. Spillover costs of those who don't/can't/won't pay for service were loaded on insurance premiums in the form of higher procedure costs.
At this point, I don't care who administers the plan. Carriers have infrastructure, Medicare has also and there are problems with both.
We know that adverse selection and the necessarily associated pre-ex excludes people. To do away with pre-ex we need all enrolled. The poor have other priorities for their 1st dollars (my econ prof called the concept marginal utility of money) and won't pay premium unless forced through a flat mandatory payroll tax and they won't buy healthcare under a HDHP unless very sick. Those not receiving a paycheck ie cash or underground would avoid paying altogether.
We could for example have a base HDHP plan with HSAs at a given income level and above with a copay plan for those with less income.
The insurance industry could design supplemental plans to fit around the core plans.
The above says nothing about paying for the plan, defining income, controlling underlying procedure and utilization costs, dealing with effect on those with employer paid plans etc etc etc.
I consider the line regarding "competition and market forces" as it relates to healthcare and especially premiums to be complete crap. Probably most who have worked through an ASO renewal understand how premiums are composed would agree.
Last edited:
