The problem with the PPACA is that it relies to a large degrees on the better angels of the insurance companies.
You probably notice the problem here. The Venn diagram of “Insurance Companies” and “Better Angels” is a null set:
The health care costs that Americans pay out-of-pocket are rising–both in total amount, which is perhaps not a surprise, but also as a share of incomes, which is perhaps more disturbing. Ann Foster discusses the pattern in “Household healthcare spending in 2014,” written as a “Beyond the Numbers” short essay for the US Bureau of Labor Statistics (August 2016, vol. 5, no. 13). She has lots of details of spending in particular areas, but here’s an overall figure showing out-of-pocket spending by households as a total amount (left axis) and as share of total expenditures (right-hand axis).
Part of the reason for this rise is that more Americans have health care insurance with high deductibles: that is, the amount you pay out of pocket before the insurance kicks in. Here’s some information from the most recent Kaiser Family Foundation 2016 Employer Health Benefits Survey. The report notes:
“[T]he share of covered workers in plans with a general annual deductible has increased significantly over time: from 55% in 2006, to 74% in 2011, to 83% in 2016, as have the average deductible amounts for covered workers in plans with deductibles: from $584 in 2006, to $991 in 2011, to $1,478 in 2016.”
One of the central conceits of Obamacare is that if “Consumers”* have “Skin in the game” it will constrain healthcare costs.
This ignores the looting by insurance companies, pharma, as hospitals, as well as the fact that the price of medicine in all forms is ruinously expensive in relation to every other industrialized nation on the face of the earth.
Obama, and the rest of his nudge theory† obsessed free market mousketeers, are completely captured by the Chicago School world view.
I would note that the Chicago boys have been wrong about everything since Mrs. O’Leary’s cow knocked over that damn lantern.
*Consumers, never citizens, because we have no significance beyond consumption.
†Nudge theory posits that by making small market based influences, you can accomplish anything without significant government intervention.‡
‡It’s also almost complete bullsh%$.