A very well written and thought out article. The lack of portability or equity in the system despite decades of payment was mentioned and it is a major problem that the ACA ignored. You can pay into a health insurance for decades without using/needing it and then lose your job or move and lose any equity you built up in that insurance or along comes the ACA and your deductibles, copays and premiums go up no matter what you previously paid into the system. The health insurance companies have been making more money for decades by increasing premiums, unloading costs onto patients via copays, deductibles etc, decreasing fees paid to healthcare providers and unloading sicker kidney failure, disabled and elderly patients unto taxpayers via Medicare. An individual can pay in for decades to health insurance and then when they need it the most because of disability, having kidney failure or being elderly they are unloaded onto taxpayers. You can argue that retirement or inability to work prevents them from paying premiums but that depends on the individual and premium. Many people over 65 on medicare pay their own premiums out of pocket yet they will never draw on the funds they paid into private health insurance companies. That means the government/taxpayers have been subsidizing health insurance companies since the 1960s.
Being signed up with an insurer used to give access to that insurer’s negotiated prices with hospitals and doctors without which patients could not afford medical care at all. However, after introduction of the ACA and its narrow networks that don’t have to pay anything for out of network care that is increasingly not the case.
I can’t understand how these insurance companies are not making money under the narrow networks, ridiculously low fee schedules they pay out, increased patient share of health care costs, negotiated contracts with health care entities and unloading of sicker and elderly patients onto taxpayers via medicare. Just where is all of the collected money going?
Lastly the type of health care in Canada and other single payer entities will never happen in the US because as soon as the number of people on taxpayer paid healthcare goes up it is subcontracted out to companies for “management”. These companies take money off the top for themselves and then ration out the care with what little money that is left over while they have cushy relations with politicians and contribute to their campaigns.
The ACA is not sustainable and neither is the previous status quo. All Washington has tried to do is maintain the status quo. Fixing the problems was never in the equation and having health insurance is no longer equal to access to care, which is why EMTALA, individual mandates etc were enacted.