Congratulations. You have finally engaged in the correct debate: the debate of the features, advantages and benefits of the ACA vs. its cost. Unfortunately, this was the correct debate four years ago. The ACA is the law of the land and just now getting into debate over the FAB v Cost is moot.
If you don't understand healthcare exchanges, your don't understand the ACA. Its a bit difficult to have intelligent debate when you don't know what you are talking about.... But every state was to set up an exchange: a marketplace where persons can buy individual insurance products that conform to ACA standards. Every state has one (oh, except those red states that threw a hissy after the ACA was passed and said they would not participate). Here is the one from my state:
Home | Connect for Health Colorado
The primary purpose of the ACA is to expand healthcare coverage to all (or as close to all as possible). One of the tenants of making healthcare affordable (to the extent we can actually have affordable healthcare in a system that is the most expensive in the world) is to pool individuals seeking coverage with other individuals seeking coverage. The marketplace helps to do that.
The fundamental axiom behind the ACA is that preventive medicine is cheaper than emergency room medicine. A main operating assumption is that we, as a society, are paying for the coverage of the uninsured at the cost of $116B per year; the taxpayers (you and I) currently pay $75B of that and the rest ($42.7B) gets absorbed by the providers. As you aptly pointed out, there is no free lunch. Someone has to pay. Well, that someone are those that buy insurance. Do you know that the average families health insurance premiums include about $1,000 per year to pay the costs of the uninsured?
Unpaid care hikes private insurance premiums by billions - amednews.com
Not only that, you are paying for the most expensive type of care: emergency room care. With nearly 46 million people without health insurance coverage, most are excluded from the preventive side of medicine. Much like spending $19.95 on your oil change next week could save you a much more expensive new engine in five years, dictating that insurance plans provide free preventative will save those insurance companies (and medicaid) a fortune in 20 years. That is why the benefits of the ACA will be realized in the long-term rather than currently. Similarly, the idea of getting EVERYONE in the system, particularly the young through the individual mandate broadens the insurance pool and shifts the emphasis to the much cheaper prevention, which shall reap benefits over the long-run. Yes, we have some front end costs by suddenly ending pre-existing condition waivers and allowing insurance companies to terminate you because you are too expensive. This will have some short-run costs for a long-run benefit that exceeds this cost.
Now, to put this somewhat in context, since you seem to be pleading the case of the marginally profitable, oppressed private insurance companies.... first, they are not. They stand to gain the most from this, as they have a mandate new market of the highly profitable young many of whom are uninsured. Moreover, the concept of "for-profit" medicine in this country is fairly new. Prior to 1980, most private health insurance was provided by the "Blues" (Blue Cross-Blue Shield), which were highly regulated not-for-profit entities; and most hospitals in the US were also non-profit charitable organizations.
I have not done the research comparing the privatization of healthcare in this country with cost, but I am going to. I would be very surprised if you could not draw a relationship that strongly suggests that since privatization our healthcare has become increasingly more expensive and less efficient. We do know that right now it is the most expensive and less efficient in the world.
21 graphs that show America’s health-care prices are ludicrous
No, from the CBO. But, given how uninformed you are on the rest of this, I guess I shouldn't expect you to know that either.
http://www.cbo.gov/sites/default/files/cbofiles/attachments/03-13-Coverage Estimates.pdf