The Affordable Care Act, aka Obamacare, is law. And its implementation is moving along slowly, but steadily. (Except when the President decides to personally amend the legislation from week to week.)
You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians. They rammed it down the American gullet like a lead ball down the muzzle of a Hawken Rifle. The problem is, once it goes off, the whole thing is going to explode.
The reasons are many, but from my perspective in emergency medicine, there are some very important issues that the crafters and supporters of the law either failed to notice or (more likely) intentionally ignored. While I’m not a medical economist, or a politician for that matter, I am a physician. And as a physician, I’m pretty darn good observer of humanity.
As the cost of insurance rises, people with limited incomes are simply going to pay the fine and go without insurance. Rather than pay $900/month for their families, they’ll pay the $695 yearly fine…unless of course the qualify for various exemptions. For some young people, this will be fine. But many will still be ill and will still show up in emergency rooms, as they have for decades, in the full knowledge that they’ll receive good care and simply be billed later. But not to worry! They can still apply for insurance as soon as they need it and not be denied. Problem is, the concept of insurance then fails. They won’t have put any money into the system, which could have been making money for the company until they became ill or injured.
Of course, many won’t bother with the fine either. And it’s the height of lunacy to believe that the government (which simply can’t imagine imposing voter ID) will actually track down and prosecute those who don’t pay. If it did, they would just call a reporter and talk about how they have no money for insurance and the fine would be dropped.
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