Personally I don't like the way the ACA is structured and would rather see universal health insurance for everyone even if it had a premium (expanded Medicare) but it's better than before for most people in many ways. And being that there are probably very few early retirees they probably have a minimum impact.
I actually came up with a rather simple, rules based compromise between a full blown single payer system and a totally unregulated market that would cover everyone to a basic level without permitting politics to distort what is covered and what is not. I can't recall anyone ever being able to poke a hole in it yet. Anyone game for that one?
These are the rules...
1) If a medical procedure, service or medication existed in any documented fashion 50 years prior to January 1st of the current year, they are covered by the national, taxpayer supported, single payer system. Period. No committee debates about what should be covered, and to what degree, etc. If the wealthiest person in the United States could buy the medical procedure 50 years ago, it's covered, but modern substitutions are
not. For example, the system would pay for the cost of a leg cast in the fashion that existed 50 years ago, but if that method is no longer in use, the system does
not pay for the modern waterproof, exothermic, quick-setting version that is in common use today. Not even at a partial degree. If your doctor doesn't have the old method, or refuses to use it because it's antiquated, there is no payment at all from the national system. The pricing of these procedures & medications would have matured decades ago, so there would be plenty of data to determine what is proper to charge. Actuaries would have no problem making this work; and taxpayers are unlikely to lose much to fraud or quackery, because there would be too much data to defraud the national system with excessive charges for the condition being serviced and no actual medical professional is going to try to charge the government for bloodletting with leeches as a partial payment for dialysis. (Just a ridiculous example of 'partial payment upgrading' that I could think of off the top of my head)
2) For a particular person, anything that could be considered medical in nature; from a triple bypass heart surgery down to an individually packed pair of aspirin from the gas station, is completely tax deductible for that person, so long as they are willing & able to provide documentation. If this deduction is not consumed in a single year, it rolls over until it is consumed.
3) Any person, business or corporation can donate directly to the medical debts/needs of another person at 100%, no matter the relationship, and deduct it at 100%, without having to funnel it through a charity first. This also covers the parent-child relationship, regardless of the age of the child. A greater degree of documentation might be required here.
4) Any person working in the medical field, with any accredited position; Doctors, nurses, nurse-pracs, medical techs, etc; may choose to donate their professional services to a charity or clinic, and deduct those in-kind donations at 100% without a limit.
This still leaves room for a dynamic, free market in medical innovations as well as traditional and non-traditional forms of insurance; but literally everyone is covered for medical care to a common, uncontroversial minimum standard.