New blow to the US Affordable Care Act (Obamacare).

[kandrathe]

I believe in a world where wishes are fishes and pigs can fly, the ACA would make things more affordable. How can it?

First, when you say more affordable, for whom are we speaking? Is it more affordable for the poor, the taxpayer, the federal government, states governments, or general society? The 10 to 20 million uninsured are forced onto insurance by threat of an IRS fine. Many of these people either didn't want it, or couldn't afford it and are heavily subsidized to get them onto it. Where does the additional $36 billion dollars per year of cost to the federal government come from? Well, a part of it was done by gutting a bit of Medicare. A part of it was done by expanding Medicaid (for the poor) and pushing those costs into state governments (which is why many states with large poor populations are trying to resist the ACA mandates). There is the part where no person can be denied insurance based on pre-existing conditions. Arguably, a good thing, however it does have a cost. Additionally, now we have an additional bit of infrastructure, and possible bit of market interference in the Exchanges. Exchanges would be probably revenue neutral, or even beneficial if they were open vehicles for free competition. But, there are strings attached to listing your plans on the exchanges, and so that introduces a source of market distortion. ACA Impact on Per Capita Cost of Health Care -- there is some wishful thinking here that the ACA will bring down costs, yet the conclusion was still unsupported by any evidence The bottom line for me is that I believe that imposing more regulatory controls on the market, forcing more benefits by declaring what a plan can/can not have, for more people, with more government subsidies is costing everyone more. I do know it costs the Feds, $36 billion more per year. I'm pretty sure my State and local governments are adding hundreds of millions in costs into their budgets. I'm not sure how it will impact me personally, except that my "platinum" plan offered by my generous employer had to be "dumbed" down (meaning less coverage) or face exorbitant penalties.

It still doesn't address the most glaring flaw in the US system, which is that when you lose your job, you lose your health insurance until you are re-employed. If it were merely an issue of the old, and the poor, we'd still have some issues with the run away costs of the social safety net.

I believe the problem of rising health care costs is manifold;

• people are less healthy (and then there are the boomers),
• more expensive drugs, and treatments are available
• due to the previous point, end of life care/treatments are extraordinary and represent the bulk of cost of health care,
• insurance covers more and more not catastrophic health maintenance treatment
• specialization and wage inflation in the high demand medical specialties,
• prevalence of malpractice and tort claims
• costs of many layers of administration of health care benefits (HMO, Group, government)
• limitations on the supply of doctors, nurses and other health care professionals -- vastly outpaced by growing demand

When I look at the above list of things affecting the price of health insurance, and compare to the ACA, I don't see how the ACA directly addresses any of them. Perhaps there are indirect affects, which could be both positive, or negative.

Physician Foundation Research - ACA Critical Issues - part I

Physician Foundation Research - ACA Critical Issues - part II