I tend to agree with the below, that the ACA will further remove health care decisions from many consumers.
‘One ray of sunshine might be an involuntary heightening of the contradictions: The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.’
Many people have been brought onto Medicaid rolls under the ACA, and some onto the exchanges, but many incentives are simply backwards, such as inducing young people in their prime to buy-in with carrots and sticks. Under this law, you, me and everyone (in theory) will eventually be forced to join the government-run exchanges.
I could easily see a massive, health-care bureaucratic complex on the time horizon of a few decades; sprawling, good for the politically and culturally well-connected along with a large swathe of people who have enough money and freedom to access it and who would often have other options available, if necessary. They would be accessing near the top, too, where there would be higher-end facilities and better points of access, and this is also where the choice jobs and opportunities would be on the bureaucratic side, as I envision a generational conveyor belt moving through the suburbs, universities and on down to Washington (a permanent coalition of majority Democrats, if other bureaucracies offer any example). People with enough money always tend to have other options, and there would be winners and losers in this set-up just like any other.
Clearly, many poor and working poor would get more care than they got before, early childhood vaccinations and urgent care, some basic access and routine checkups, but again, in a world of limited resources, they would get promises but not always delivery. There would definitely be more availability for some and lots of brochures and ‘nudges’ that usually don’t work as advertised.
Of course, paying for these folks would be many others who are working poor and non-poor who could very easily be getting the short-end of the stick: Paying for all of this and perhaps getting very little in return and having no other options and virtually no political recourse. Such people would be paying for an immovable bureaucracy and more politicians controlling more of the money supply. They would be paying for more union control through the activists who benefit from the law along with the standard corruption and inefficiencies inherent in such systems. Such folks would sometimes be working against their own interests, disincentivized and unfree.
Richard Epstein looks pretty prescient on what the law’s specific challenges are:
‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily’
Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’…Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’
Related On This Site: From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’…From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’