Do the Pros Outweigh the Cons of the Affordable Care Act?
Introduction
Before the 1970s, the majority of people held hospital insurance. For instance in the ‘40s, only a tenth of the population actually had private health insurance. Just forty years later, that trend was reversed and a little more than 10% were uninsured—everyone else had bought insurance (Morrisey, 2013). This was a result of the subsidization of care by the government, which raised the price of care and which prompted more people to seek coverage. Jobs offered coverage as an incentive to come work for them, but with the increase in premiums and deductibles more people are seeing even insurance as too expensive and are now avoiding health insurance and health care altogether. What the Affordable Care Act (ACA) did was to expand taxpayer-funded care through Medicaid and Medicare while obliging individuals to purchase insurance at rates that continue to increase by huge percentages year over year (Trish & Herring, 2015). The result of the ACA was that health care was more possible for more people—but it was anything but affordable for those who could “afford” to pay for it. Moreover, the manner of health care was still at best questionable, as Goldhill (2009) has shown: instead of practicing preventive care, providers are incentivized to merely “treat” patients, conduct unnecessary tests, and overprescribe. The latter has led directly to the current opioid crisis (Rothstein, 2017). Thus, the Affordable Care Act has not done much in the way of bringing positives to an already dysfunctional health care system; on the contrary, it has added to the problems by leading insurers to raise their premiums and deductibles to unheard of levels. This paper will show that the pros do not outweigh the cons of the ACA.
Background
The Affordable Care Act was set in motion by President Obama to address several variables that hindered the treatment and prevention illness as a result of lack of access to care (Jacobson-Vann, 2011). The ACA was meant to eliminate “lifetime and annual limits on insurance coverage” while obliging providers to engage in “preventive services,” grant “access to health insurance for individuals with preexisting medical issues,” and ensure that states had the “flexibility to establish health care programs for low income non-Medicaid eligible clients” (Jacobson-Vann, 2011, p. 100). These were the pros. And while Rosenbaum (2011) lauded the ACA as a “watershed in U.S. public health policy,” the reality was that health care had already become a profit-driven industry and that the ACA did nothing to address this issue (Matthews & McGinty, 2010). This was the main con—and it was and is a big one quite simply because the profit-driven nature of the...
The problems are not that there is too little access to health care; the problem is that the type of care that is given is not really appropriate because the motivation for care is profit-oriented rather than patient-oriented. This fact alone makes the industry problematic as a whole. Goldhill (2009) shows clearly that the system is based on incentives that put too much emphasis on treatment rather than prevention (and even though the ACA incentivizes preventive care, it does not go far enough in removing incentives associated with treatments that are unnecessary and costly). Goldhill (2009) goes on to show that many deaths result from a failure to practice preventive care, and therefore the essence of health care reform should focus on that failure. The ACA instead focuses on treatment and government subsidies. What looks like a pro—government subsidization of health care—is actually a problem (or, in other words, a big con) because that subsidization guarantees that there will be a payer. When there is a demand for a service, prices go up—that is a basic law of economics. Moreover, wherever government gets involved, subsidizing an industry, prices go up: this can be seen in everything from education to housing.
What’s worse is that the ACA’s main so-called “positive” is really a negative: the ACA focuses on expanding the role of insurance when what it should have focused on is reducing the role of insurance and eliminating the type of financing that has turned the economic model of health care in the US into a farce that will result in prices going up even higher while health and quality care decline ever more steadily. It is almost as though the government were colluding with pharmaceutical companies to keep health care patients on drugs. And, in fact, it would appear that they are (Semuels, 2017), as lawsuits against Big Pharma accuse the drug makers of being responsible for the opioid epidemic sweeping across the U.S. The ACA has essentially supported this epidemic by subsidizing this type of treatment.
Goldhill (2009) suggests that “the most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for…
