Agreed that much of the health disparity is due to a very large percentage of the population not having access. I disagree that the ACA changed that substantially. In fact, many people who previously had decent coverage are now in the zone of super high deductibles and will opt to avoid health system contact. For those locked out of the system in the past it is great to now have access!
If you contrast the US system with the Japanese system (I know, different cultures blah, blah) it is like night and day. Their system is all private insurance, everyone has it. There are no bankruptcies due to health costs in Japan --- zero. As mentioned previously, the cost of everything is cheaper --- MRIs are like $50, hospital stays are under $100 per night etc.
The coolest thing about their system is that no appointments are needed. You simply show up at any doctor's offices (heart, brain, GP) and the Doc sees you without much waiting. They are in the customer service business.
They also use the health system far more than we do but spend about 1/2 as much.
So the debate should really be -- "why the hell are we not adopting the Japanese health system here?"
I don't think it's fair to say the ACA has made access worse for certain people. Medical cost inflation has been doing that for a long time and increased deductibles has been a growing movement in the industry--intentionally so as a method of cost control. It's easy for people to associate their plan changes with the ACA, but coinciding does not mean the relationship is causal. Also, their old plans likely weren't as good as they thought they were because they didn't have anything really expensive happen to them. Many of the old plans would suddenly show themselves to be very limited if you actually needed to use them for more than routine care.
We don't just have the Japanese system as a model to pick from. Literally every other major industrialized nation has a national healthcare system that works better and is much cheaper (like 50% to 70% cheaper) per capita.
Agreed that there are many countries with better and much cheaper options. (anyone who wants to argue about Japan is welcome too --- I'm not that current on it and the statements I made were taken from my memory of a PBS documentary a few years ago)
I think the whole 10 Million more people have enrolled in the system argument falls flat. Being enrolled does not mean your health outcomes improved. Proponents of the ACA in congress are now wringing their hands trying to figure out why so many people aren't going to hospitals or doctors.
Or that prices would have risen anyway for that matter. Prices have risen over the last 5 decades primarily due to the inflow of Government money at virtually every level. I'm not talking just Medicaid and Medicare either. A vast majority of the population is either directly or indirectly employed by Government and their so called insurance is funded by Government. (think teachers, public employees, police, military, government contractors and healthcare providers themselves)
A much simpler system would be to simply allocate to each person a certain amount of health dollars over a lifetime. Set the rules so that if the dollars are not spent that they can be passed down to heirs or charities. You would then find the sweet spot where people take personal responsibility for both their health and their spending. Health care providers and drug manufactures would not like this at all.
The incentive for all health care providers is to charge more and to provide more service so the ACA plays into that paradigm nicely. That is why it was written with the stamp of approval of the health industry lobbyists.
The second major change should be that all health providers must publish their rates for each procedure. It would also be nice if they published efficacy data such as "statin drugs lower your cholesterol but don't significantly extend life and have some nasty side effects" or "heart bypass surgery has never been FDA sanctioned and the outcomes are statistically better if one simply eats more vegetables and exercises"
As another point just to muddy the water more --
A staggering huge amount of so called health care dollars are spent at end life. The sad part is that the quality of life for those spending the dollars is worse than those who chose to die without intervention.
"30% of all Medicare spending is attributed to 5% of beneficiaries that die each year and 1/3rd of that in the last month of life."
http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/You have a system that is burning money and resources that A. decrease the quality of life and B. attempts to extend life beyond a reasonable level.
It is in fact not a "healthcare" but a "sicknesscare" business. They don't make money when you are healthy. They make money when you are sick.
So imagine a situation where you or grandma have significant health problems --- What if you were given the choice of A. having lots of interventions and money spent on you with the result being that your quality of life sucks and you die at or about the same time or B. foregoing the medical interventions, dieing naturally and designating that the financial resources be added to your grandkids accounts.
My personal experience with the ACA has been dreadful --- just awful --- Our rates at our office for our 10 staff have nearly doubled while our deductibles and premiums have skyrocketed. My understanding is that this is not unusually. It is folks like us who are now pretty much without insurance except catastrophic. How else would you term paying 10K in premiums per person per year with 3K deductible?
At lastly, just to get this rant off my head --- In or around 1999 our cost per employee was 90 dollars per month for 500 deduct. Rates were rising at 20% per year. We said this can't happen because cost will double every 4 years. Well thankfully that didn't happen but instead rates doubled every 5 years while deductibles did as well.
The problem is that as this process continues (and the trajectory is unmistakably clear) that within 5 years our rates will be close to the our salaries and deductibles will be in the 10-20K range. So we will be paying 25K per year for insurance that no one can afford to use.
Anyone who likes can argue in favor of the ACA and I agree with the access to care aspect of it but I'll be damned if I'll fall for any argument that our system is efficient or in anyway in the same league as the top 10 systems in the world.