The Patient Protection and Affordable Care Act, popularly known as "Obamacare," was signed into law five years and one week ago. Here's a compact seven-and-a-half-minute video clip assessing how well it's working from prolific writer and commentator John Green, who incidentally buys his own coverage through the healthcare exhanges.
It's worth clicking through to YouTube because the video's description contains a bunch of links to additional information, making it an excellent reference on the subject.
If for some reason you can't watch the clip, here's my summary of what Green has to say:
- Government spending alone on healthcare in the United States (not even counting private spending) is far higher per person than in such countries as Japan, the UK, or Australia. Total U.S. healthcare spending (public and private) is more than 17 percent of our economy versus less than 10 percent in France, Australia, the Netherlands, and many other developed countries with outcomes as good as or better than ours, and in those countries everyone or nearly everyone has insurance.
- The U.S. has sort-of universal coverage for some things, such as emergency care, because if you go to a hospital you will almost always be treated for anything urgent. But if you can't pay, the rest of us end up doing so through higher fees and taxes, which ends up being very inefficient. Moreover, it doesn't cover treatment for chronic illnesses (which is one reason people die in the U.S. because they can't afford care).
- Prior to the ACA, insurance companies were allowed to turn people down for individual coverage if they had preexisting conditions (which even meant, in a specific case John mentions, ringing in the ears). This discouraged a lot of people from working for small companies or starting their own businesses.
- On average, insurance premiums have been rising more slowly under the ACA than they were before, and it's also costing the government significantly less than projected. (John doesn't mention it directly, but the ACA is also lowering the federal budget deficit, and done so even more than it was expected to.)
- Crackpot claims like "death panels" and "government takeover of healthcare" have of course proven false.
- Aside from a few modest tweaks -- insurance exchanges and premium subsidies for individual policies, no coverage denial, higher prices, or cancelation for preexisting conditions, and the like -- very little has changed. We still have Medicare, Medicaid, the VA, and private insurance companies and doctors, as well as for-profit, non-profit, and county hospitals, and most people under 65 get coverage for themselves and their families through their jobs.
- Has the ACA worked? Yes and no. Yes, many things are greatly improved, millions more people are insured, and there are even signs it has led to some overall improvements in health. But, no, it hasn't led to universal coverage or the lower costs seen in other developed countries. Dealing with those problems would require bigger changes than the minor ones introduced by the Affordable Care Act.
Incidentally, a couple of years ago John did a video on why U.S. healthcare costs are so high. You can find it in this earlier post. He starts by saying this:
I want to talk today about why healthcare costs in the United States are so phenomenally, fascinatingly expensive, but first I have to blow your mind.
All right, so you've probably heard that the reason people enjoy quote-unquote "free" healthcare in Australia, in the UK, in Canada, etc. etc. is that they pay higher taxes. That money then goes into a big pot and is used to pay for people's healthcare. But in fact, in the United States we spend more tax money per capita on healthcare than Germany, Australia, the United Kingdom, or Canada.
(More than other countries as well; see the video.)