I think that we are headed in the direction of a Medicare-for-all type system, but mostly at the hands of the Republicans. More and more Republicans are identifying with libertarian politics, and if they can't stop their extravagant spending to support special interests and warmongering around the world, not to mention the losing battle against homosexuality and small-time pot smokers, then they won't be able to win elections in the very near future.
I actually think that whether the ACA works or not, that it's most likely at this point to be a hindrance to a universal system. Either it will improve things a little bit (that is the best case scenario as I see it) and voters will be satisfied with the bandaid and not wish to disturb things again so soon, especially considering how tumultuous this ride has been over the last few years. Or it will just make things even more expensive for most voters (more likely IMO) while making doctors even more overworked and reducing their per-patient pay, in which case the people will be hesitant to trust the government to actually make things better.
In terms of health policies, can you tell step-by-step processes that you would picture from now on towards "a Medicare-for-all type system...at the hands of the Republicans?" What are health policies that these Republicans would implement that are not "intentionally flawed" to get from post-ACA to "Medicare-for-all," so that they can be elected? How do you know if these bills will more likely pass? What will happen to numerous corporations? Are they going to lose their power over time and will they allow that at all?
ACA seems to be a hinderance to a universal system, more because of how much it takes to pass a bill, rather than it is intentionally flawed or bad in its design. If ACA was promoting universal systems, like many presidents did since early 1900s, it would not even been passed at all and this type of healthcare reform would not have happened in the first place.
TL;DR: If you look at the history and how "socialized medicine" was first used in our healthcare debate 50-70 years ago, you will see that we have a bigger problem than just ACA and realize how it is
so unlikely to move towards "a Medicare-for-all type system."
And I flat out deny this claim, as giving public money (subsidies) to private businesses (insurers) isn't a more privatized system than one in which private money is given to private businesses, even if the amount of money going to the private businesses is greater in the first scenario. Wealth redistribution is just as immoral when the money is going to the rich.
In fact, think about it. Any country with a Medicare-for-all type system (like Canada, for example) would fall into that description: public money is going to private businesses (doctors and hospitals). But that's definitely not more privatized than the pre-ACA (or even post-ACA) American model.
This is a problem libertarians regularly face when having economic debates with progressives and liberals (I don't mean those terms to be derogatory any more than I mean "libertarian" to be derogatory). We are constantly being told that "the free market doesn't work," that privatization doesn't work, and that capitalism doesn't work because we are in such a poor state of affairs right now in the US. But real libertarians don't support corporate welfare or crony capitalism, which is what we actually have now. The ACA is just going to add to that, which is not something most of us would support.
I wasn't talking about the states, I was talking about Obama and congress - the people who came up with the plan in the first place.
Canada has a social insurance system where although physicians and hospitals are not owned by government, reimbursements come from public money, so I agree that public money does go to private businesses (doctors and hospitals). However, this is more privatized than pre-ACA, because of insurance companies in the U.S., where it has no social insurance system like Canada. Canada did not privatize, in general, insurance models as much as the U.S. did.
ACA drives further privatizations, because there are other federal subsidies that promote more innovative healthcare delivery models, and other corporations started to emerge. More money will flow towards even more corporations. Insurance companies will be even more influential since their pool of clients increased.
We can talk all day about how immoral wealth redistribution is. But as I said before, in the eyes of corporations looking down on civilians like us,
it simply does not matter. All they care about is to increase the profit margins, and no matter whether it is immoral or not, they will pursue it nonetheless by interventions on marketing, governmental and other private sectors, professionals and so on. Think about it in their perspective. Someone is leading one of large insurance companies, and does he or she even care whether the public says it is immoral to receive more money than they should? Nope. It does not matter to them so long as they have that money flow.
About the corporate welfare or crony capitalism, I would not blame ACA directly. I would rather blame the system--the lobbying of numerous corporations in the government that only support laws that benefit them and deny otherwise. In this system, you cannot reform healthcare without addressing the corporations' interests. Otherwise, for example, the public option in the exchanges would not have been omitted from ACA. How would you address the corporations' interests while addressing the insurance coverage gaps, so that corporations will support the law as well as the public? If you think about it this way, ACA seems a reasonable, understandable approach that was passed to become a law.
TL; DR: If ACA or Medicaid expansion are "intentionally flawed" and "don't work," what would you have done differently? Did Democrats put forth an intentionally flawed model? Then, how would you suppose what we should have done instead of ACA? More importantly,
how do you know that these bills will more likely pass?
Meanwhile, they're requiring everyone to go out and buy insurance - except the extremely impoverished in 28 (I think?) states who are still being denied insurance because they can't get subsidies and the mandatory medicaid expansion was unconstitutional - from the few insurance companies that are able to provide ACA-compliant policies.
My comments about the states refer to this comment.
These ~25 states themselves chose to deny the Medicaid expansion for political and economic (tax raises) reasons, rather than "still being denied." I added a NYT article directly discussing this issue a few pages back. I am unaware of whether it was the state government or insurance companies or both that said it was unconstitutional; however, they "can" get federal subsidies should they chose to expand. Why did you say they "can't" get subsidies? They did not choose to expand and thus decide to forgo subsidies, because they in part believed that even with federal subsidies covering 100% of Medicaid costs until 2016 and covering 90% after 2016, tax raises in 2016 seemed inevitable and this would seem burdensome economically in the future. Was this "intentionally flawed" made by Democrats? Then how much more subsidies should there be? 100% coverage of Medicaid costs until and after 2016? What would you suppose to do differently?
For states like MO and IL, I understand economically. But for many other Republican-led states that chose to deny, were states like Texas really poor? Did they see this was unconstitutional in a nonpartisan, logical manner? I don't have the answer, but my guess is that I highly doubt it. Some of their decisions to deny the expansion are reasonable, while others probably are politically biased.
TL; DR: Mandatory Medicaid expansion was changed to voluntary Medicaid expansion, so being mandatory seemed unconstitutional from the court and the law was changed. However, my argument above is primarily about Medicaid expansion
itself. Unless you are talking about Medicaid expansion
itself being unconstitutional, I initially thought you and I agreed on this topic, and that was why I said my previous post echoed some of your statements.
