Does anyone really think that the health care system works?

I have always been mystified by the opposition to the Affordable Care Act, which is sometimes referred to as “Obama Care”. The fact that our healthcare system is broken seems obvious.

Before the ACA, medical costs had been growing faster than inflation for years. Like most people, I spent more and more money on medical insurance and got less and less.

Such a broken system could not continue. To the extent that a market existed for medical insurance, it was not working. When markets completely fail, as they have with medical insurance, government solutions can help fix the problem.

One example of how broken the medical system is can be seen in the billing for a set of routine lab tests that I just had:

  • Total cost for tests: $387.81
  • “Insurance discount”: $348.51
  • Billed cost for tests for an insured person: $387.81–$348.51 = $39.30
  • Insurance payment: $16.42
  • What I have to pay: $22.88

The “insurance discount” is obscene. As I understand it, this means that an insurance company gets billed for the tests at a dramatically reduced cost. But if you walked in off the street and got the tests, you’d pay the full amount ($387.81). Why is it legal for an insurance company to pay so much less than someone without insurance, for the same services?

When it comes to actual payment, I am paying more than the insurance company, despite the fact that I have an expensive “Blue Cross Plus” insurance plan.

Billing for medical services is broken at every level. The ACA has started to address some of these issues and held out the hope that medical costs could be brought under control.

Yet there is a significant portion of the population that is outraged at the ACA. The medical system works no better (and probably worse) for them than it does for me. How can people not see the need to reform such a broken system?

The ACA is far from a perfect law. But it held out the hope that the situation could be incrementally improved. The increase in medical costs was reduced. My hope was that eventually medical insurance companies would be treated the way utilities are: they would be closely regulated by the government.

Now the Republicans want to repeal the ACA. They want to return us to the pre-ACA era when medical costs were out of control and over 20% of the population didn’t have insurance. Because the old system of medial insurance worked so well.

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