I think you have to define why “better healthcare” = “living longer”, as I think that living longer probably has an awful lot of factors beyond access to the medical system, starting with prenatal nutrition. Life expectancy isn’t declining because people don’t see doctors, but because a million people died of Covid and quite a lot of people have died from addiction.
And while we have improved healthcare access (which is not synonymous with “healthcare system”) we haven’t made that universal. If your deductible is $5k, plenty of people still can’t afford to go to the doctor.
OP, I'll take this a bit further even. Healthcare policy reform is focused on increasing value, defined as the intersection between cost and quality. By everyone in the field.
You're free to select solely life expectancy of a developed nation as your quality metric. Please note that the experts in the field (I have 10+ years of experience in this field) don't ever select one single metric and this metric is not a good one for broad inference. Notably, this metric is moderately resistant to insurance-based changes for developed nations . Many of the known changes for those that work were implemented by ACA. To throw a grenade, what do you think the life expectancy of children who would've been aborted pre-overturn is, knowing what we know about the socioeconomic status of such children?
I know you said you wanted to hand-wave away 5-6% decreases in cost but let's be clear about this number. That's 240 billion dollars a year and a decrease of 4% of
all government spending. Here are the categories you can pick one from to now get for free:
Veterans Benefits and Services
Education, Training, Employment, and Social Services
Commerce and Housing Credit
Transportation
Other, as in everything not listed above or in the big 6, two of which are health and a third is debt service.
By the way, health costs have an interesting distribution. Chronic conditions and inpatient care have a gigantic share of costs that are mostly invisible to you unless you have them. This makes discourse hard and it's hard to understand the impact of preventative policy, floor setting, and access to care. The example I usually use is I'd happily pay a homeless person $100 to go to the doctor once a year, plus transportation costs, and $5 to take free insulin instead of paying 250k for their leg to be amputated emergently.
It's healthy to have this discussion but even a cursory review of the data shows ACA has significantly impacted costs positively and has increased quality modestly. Not to pick on you, but look again at the Alaska article and listen to the experts in it...
It’s just the NIH and the CDC
This is near the end but it highlights the authors point succinctly, that the fault is not with the ACA or it's oversight. Explicitly, the experts in this field highlighting the same metric as you are not aiming their ire at the ACA at all.
Then, last week, more bad news: Maternal mortality in the U.S. reached a high in 2021. Also, a paper in the Journal of the American Medical Association found rising mortality rates among U.S. children and adolescents....A big part of the difference between life and death in the U.S. and its peer countries is people dying or being killed before age 50. The “Shorter Lives” report specifically points to factors like teen pregnancy, drug overdoses, HIV, fatal car crashes, injuries, and violence....Two years difference in life expectancy probably comes from the fact that firearms are so available in the United States,” Crimmins says. “There’s the opioid epidemic, which is clearly ours – that was our drug companies and other countries didn’t have that because those drugs were more controlled. Some of the difference comes from the fact that we are more likely to drive more miles. We have more cars,” and ultimately, more fatal crashes. The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income
We know life expectancy is dominated by young deaths. The old people things that are going well are exactly what was incentivized by the ACA. Teen pregnancy and firearms? Increases in the former are caused by horrifically performing abstinence-only education, lack of access to contraceptives, overturning roe, poverty, and violence in video games (jk). Read their emphasis on non-insurance factors here and think what kinds of policies make this better and what kinds make it worse.
Yes, Americans eat more calories and lack universal access to health care. But there’s also higher child poverty, racial segregation, social isolation, and more. Even the way cities are designed makes access to good food more difficult.
Socioeconomic problems are more important than ACA. Poverty reduction and anti-racism investments are part of access to care as the term is used in policy research, and ACA funds experiments in this through CMMI. That is, some of the increase in costs due to the ACA are aimed directly at these problems.
American life expectancy is lower than that of Cuba, Lebanon and the Czech Republic......fact that living in America is worse for your health and makes you more likely to die younger than if you lived in another rich country like the U.K., Switzerland or Japan......The NIH should undertake a “thorough examination of the policies and approaches that countries with better health outcomes have found useful and that may have application, with adaptations, in the United States,” the authors wrote.....the focus should instead be on the fact that every other rich country has been able to figure out how to help people live longer, healthier lives.....England, France, Italy...Some of the policies he’s identified as helpful include universal, better coordinated health care, strong health and safety protections, broad access to education, and more investments to help kids get off to a healthy start. These policies are “paying off for them,” he says, and could for Americans, too.
A homework problem to show you're invested in this convo not just doing a democrat bad drive by on RomneyCare: tell us, for each of those countries, if they are more like pre-ACA America or like we didn't go far enough on the ACA. Tell us if you think these authors think the ACA was an improvement or not.
It's totally fine to think we could have done better than the ACA. But we should get the facts right and be careful about throwing out bipartisan bathwater lest we resign ourselves to getting our time machines out and play the blame game. I'll start by acknowledging it was unfair of me to act you linked this article for anything other than the headline image, which was very understandable to do. I couldn't resist since it's essentially experts begging people to support social welfare policy and go even further than the ACA :). I'll also commend you for seeking out data.