The Rotting Corpse of the ACA

 I'm not a fan of the 40+ day Government shutdown, but one positive is shining some light on the ACA.

I blogged about Healthcare Reform in September 2009. At the time, what was to become "Obama's signature achievement" was being bounced around in the halls of Congress and our media was doing it's best to keep us in the dark. Few folks could understand the basic underlying principle, and nobody except the Architect (Johnathan Gruber) knew the details - not even Obama.

Gruber sold the bill to the public by the mushroom farming approach (keep them in the dark and feed them shit). He kept Congress partitioned into special interests, and he gave Obama plausible deniability by not filling him in on the details. In the end, we latched onto a quote from Speaker of the House Nancy Pelosi -  "We have to pass the bill so that you can find out what is in it", and Obama's "if you like your health care plan, you'll be able to keep your health care plan". Regardless the obvious deception, the ACA became law in 2010 with full implementation delayed until 2014.

I used the Health Marketplace as an individual (not part of an employer plan) from 2014 to 2023. And has been repeatedly reported by others, premiums skyrocketed and coverage declined (rising deductibles). People whose employer managed the benefit were somewhat oblivious, depending on how much the employer subsidized.

Note: The ACA was nearly repealed in 2017 after passing the House but failing in the Senate by one vote - cancer brain McCain.

Ok, enough with history - I think everyone gets the irony of "AFFORDABLE Care Act".

The ACA was written by insurers and  providers, and reflects these group's financial interests. As is oft the case with making "the way we've always done it" law, i.e. set in stone, there is no way to curtail the rising costs of medical care - hence ever increasing premiums, or in the shit-stain era (Biden), taxpayer subsidies.

There are some interesting opportunities to effect intelligent change in the US healthcare, but any serious change is predicated on Congressional willingness to creamating the rotting corpse of the ACA.

Covid opened the kimono of the Federal Governments existing systems (NIH, CDC, FDA) so the public could see just how pathetic they are. It also, (hopefully), educated the public to realize that healthcare in America is not one giant monolith, but rather a very loosely connected network of ~7000 hospitals that seem more focused on protecting themselves from malpractice suits, than practicing effective medicine. (I remember trying to rank hospitals on their covid care and discovered they siloed that information out of reach of mere humans like myself).

So change is needed, some change is easily within reach (structural), change due to AI is probably 5 years out (assuming Congress removes impediments).

I would love for a healthcare overhaul to be Trump's signature achievement. I wonder if Elon has some extra time...