The downside is that we remain saddled with a poor law.
The upside is that maybe we can get a bipartisan system installed.
The problem is that no sensible proposal seems acceptable to both sides.
I do agree it's a bad law. Being forced to purchase private insurance by virtue of being alive, is a terrible precedent that I'm still surprised was found Constitutional. I do not agree with that precedent at all.
However the ACA is here and is the law of the land, and has not been nurtured for seven years. It wasn't even left fallow. But rather it was picked at, cut way, and hobbled continuously over the seven year period. It was demonized to the point of lies & libel, and politicized like nothing before in American politics. An entire majority party built its political platform around killing it, making it their central tenet, their mission, indeed their raison d'etre!
And yet today here it stands, having added many more tens of millions to the insured rolls than any competing plan, and it enjoys a positive view - however slight - from the American public in general.
While I despised it then, and still do, I saw it as a hope & start towards single-payer health-care. So I very begrudgingly accepted it as the law of the land, and waited for the improvements I hoped would come. Of course, those never happened.
So how to fix it? I'd move straight to a step-wise gradually implemented Medicaid or Medicare expansion, done over a decade or so. But this will not happen, at least today.
However last night I heard these excellent ideas from a moderate Republican House member, but I didn't get his name:
1] Add a public option, which would insure insurance in those markets with few, or soon to be none, insurers.
2] Separate out the healthy from the high-risk, then remove the high-risk thereby stabilizing the markets and promoting more free-market competition and market expansion, and lowering premiums.
3] Take the high-risk group, and allow them to buy-in to Medicaid.
I like this proposal. And I think it's reachable via Congress, within ordinary rules of order. The Dems would take it in a heartbeat, and the question becomes: "Can they pick-off the few Repubs they need to pass it?"
This proposal of course inches us a little closer to single-payer, but I'm fine with that. I see no free-market solution, or at least no totally free-market solution, to this problem! Apparently, neither does the rest of the 1st world.
Winston Churchill once said,
"You can count on Americans to do the right thing ... after they've tried everything else!
I'm hoping this is exactly one of these moments.