I used to be disgusted, and now I try to be amused.

[Greedy,Greedy,Greedy]

Originally Posted by taxwonk

The reason that people don't distinguish between ACA and the healthcare market generally is that ACA failed to provide an affordable means for lower income people to obtain health care. They should have set up a public option. They failed to do so. As a result, too many people are left in the unfortunate position of being forced to pay either a premium they can't afford for coverage that is illusory, or paying a penalty they can't afford for failing to obtain a policy that doesn't provide any actual benefits.

The ACA was a good bill in the limited sense that it did way with lifetime caps and pre-existing conditions. Other than that, it's about as useful as tits on a bull.

There is lots of other stuff in there that is very helpful - including provisions that are moving us from a service-based to outcome-based reimbursement scheme, which is the best bet for controlling care in the current system.

I'd have loved to have seen a public option, but having a public entity contracting wouldn't have significantly altered the price structure in health care. Public entities are already among the largest purchasers of healthcare in the US - why would adding another to the mix be hugely different? It might make some different, which is why I'd like it, but nothing radical.

The key way ACA planned to help the lower income seeking healthcare in particular was through subsidized insurance and an expansion of Medicaid. Of course, a lot of states have opted out of Medicaid expansion, to the disadvantage of their citizens, but there is a fair bit of subsidized insurance out there.

I won't pretend to have a lot of answers, but the reform I'd really like to see next would be to make the US part of a bigger market for drug approval and distribution - so we had, for example, a common drug market in the EU and US. Drug companies would have less hassle in approvals but we'd get the benefit of systems that have been much more successful at keeping drug prices down. I'd be hoping the larger market supported innovation, even if the approach took a lot of money out of the pharma pipeline.

Parts of TTIP might have set the stage for this, but with the TPP dead, we can be pretty certain that's going nowhere. And with Brexit we don't even know if EMA will continue to hold for the UK as well as EU.