For people in Europe and elsewhere who think the ACA is similar to your systems—forget it. It’s not like it at all. If it were, I’d be a bigger supporter.
In theory, it’s supposed to work like car insurance. In the 1970’s a serious problem was starting with car insurance. People who considered themselves to be “good drivers” wouldn’t bother getting car insurance. People who were “very bad drivers” wouldn’t get it because it was too expensive. When someone got into a bad accident with an uninsured motorist, usually their insurance company would have to pay all the damages and that person’s rates would go up—making that person drop their insurance because they couldn’t afford the new rates. Not having car insurance mandatory was costing a lot of money.
So State by State, and finally nationally, car insurance was made mandatory. Because everyone who drove was required to get it, rates really did go down. You could get good rates for good driving habits. Bad drivers could get insurance because insurance companies were forced to take high risk people by law. The bad drivers went into a pool and insurance companies would randomly get assigned the bad drivers so the risk was spread evenly. And if you were caught driving without insurance, you could get a heavy fine or even serve jail time. This worked at the time, and still works today. Car insurance is affordable because of these laws.
People thought this law would work for healthcare. If you made EVERYONE get health insurance, rates would go down. All of the healthy people who don’t use health insurance would be chipping in so the really expensive sick people wouldn’t have to pay so much.
I don’t think it’s working out that way. First of all, people forgot about some serious differences between healthcare and driving. If you are too poor to pay for insurance thesedays, you don’t drive. If you don’t want to pay for car insurance, you can choose not to drive.
The requirements for healthcare are—if you are alive and a US citizen, you need insurance. You can’t choose not to be alive if you can’t afford it. So they put a minimum salary cap on who has to pay for insurance. 75k. If you make less than that, you don’t have to get insurance. So already, there are a huge number of people exempt from the law. The pool of healthy people has diminished. So rates won’t go down the way they did with car insurance.
Another difference if you are a REALLY bad driver, you lose your licence. You also no longer pay car insurance. So if you truly are a horrible risk, you are out of the pool altogether. This doesn’t happen in healthcare. You can’t put someone in jail for getting cancer too many times. You can’t forbid them life. So they stay insured. So unlike car insurance, you have a lot more people at the “bad” end of the scale because you can’t kick them out if they get too sick.
Another big difference is—good drivers and bad drivers tend to stay that way. A good driver has control over whether or not they stay that way. They can obey all the traffic laws and do everything right. It’s mostly in their control whether or not they get in an accident.
It’s not that way with healthcare. You can go to the gym and eat healthy, not smoke and still get cancer and wipe out your “good” track record overnight.
Another way health insurance and car insurance are different. When people get older, their reflexes slow down. Their eyesight isn’t as good. People tend to stop driving when they get older. With healthcare, they tend to use it a lot more as they get older.
Honestly, I don’t think the ACA is a workable system. I guess it’s better than nothing and it’s probably all we’ll get in my lifetime. Even though it sucks, I think it’s been overly demonized. People have been raving lunatics talking about death panels and people going to prison. It’s just ludicrous.
—
As an aside, the first time I heard about the ACA, it was 2007 and four different conservative republicans came to me saying this was the great solution to our problems. Obamacare was thought up by the Heritage Foundation—a conservative think tank. It was first enacted by Mitt Romney—a conservative governor. It was considered the best free market option available. I think the only reason people are screaming now is because a democrat put it into effect.