I still don't understand how the ACA makes things worse.
I used a pothole on the bridge analogy. In itself the idea of increasing the number of insured is a good thing. You'll not find a post of mine anywhere stating I want access curtailed.
That said, when one is arguing about the surface while the foundation is crumbling means collapse.
The ACA is more than just making more people able to get insurance, it is a foundational regulatory cornerstone. It is the Golden Rule. It passes out the gold so it makes the rules. So you cut back on payments. What's the worse that could happen? How about a promising study finding valuable insights about traumatic brain injury being shut down? Huh? Yeah that happened. Someone I know worked on that in a large teaching hospital which does research. Some of the money that comes in goes for those kinds of projects. Income is going to go down and as always happens research is one of the first things to go. Casualty of war. "The Club" isn't always the most rational way to have people work better. But the bureaucracy is now being established and you will not be able to fix that. It is it's own thing.
So the aging population will cost a few trillion dollars over and above what we have. Health care workers will have strong disincentives to go elsewhere, because what you will have is "productivity", that is more patients per unit time. You will have staff reductions. You will not have the right people in the right places doing the right things when needed, but you'll have the ACA.
It was not well thought out and in the minds of most it's a synonym for health care. It is not harmful in the sense that many think of. It's not going to make dogs and cats live together in sin, to quote a movie. It is no worse than putting a dirty band aid on a cancerous lesion and working around the real problem and pronouncing it a solution. That's the problem with it.
We as a people do not plan well. We kick the can down the road, but there have been moments of opportunity where we did move. Sometimes it was for good and sometimes not, but there was the Manhattan Project and Apollo in the last century. Both came from a perceived need. Insurmountable obstacles were removed. The best and brightest were allowed to do work for a common purpose. A failed project was the Maginot Line and there was nothing wrong with that either. Yes, perhaps the ACA is just that.
Nevertheless, we had moments of missed opportunity. We had the Oil Embargo, a wakeup call for energy independence. The reviled by some Carter recognized this and tried to do something, but other politicians crushed the initiative.
Then there was 9/11. It was a rare moment when we had the sympathy of most of the world. Even Iran had student protests supporting us, the only positive encouragement in that part of the world. Wisdom would have prescribed action to reach out to others, some of whom we did not see eye to eye with to work with common purpose for mutual security and perhaps, finally, find a way to a sane world. We got the Axis speech, which resulted in our current predicaments in the ME region, and an even more hostile situation. What was wrong with calling out people for doing wrong? Nothing, of course, provided that you ignore the consequences of the act.
Likewise, we had a moment where health care reform proper might have been had. The nation was looking to improve our system and address things they didn't understand, but realized at some level had to be resolved.
Obama and the Democrats rose to the occasion with their Axis wisdom, their Maginot solution. Recall that in themselves and in limited context nothing was "wrong" with them.
That is the real tragedy, a wasted moment. A few wanted to examine the system and determine without political or profit driven skulduggery where we were, determine possibilities, get a realistic assessment of costs and what each would and would not do. Find ways to implement solutions that would enhance the patient/provider relationship, which is the foundation of health care. Give tools to help. Provide a system for rational treatment. Implementing with a key goal being to minimize the laws of unintended consequences. To have legislation and regulation facilitate the process, not rule by politics. To have quality care without excessive and redundant testing. So much more. We need so much more. The costs of Alzheimers is projected to be 1.2 trillion dollars. Other diseases such as diabetes, heart disease, and so forth will add to that at least as much. The "solution"? Cut payments?
Where will the next generation of providers come from when the sentiment here seems to be that they need to work harder and longer for less because like teachers they should be doing it on principle. IF you can get enough qualified (note that word) people, which goes far beyond book learning, how will they be trained? How to allocate resources? What solutions do we have now?
This is what I hear.
"Well it's better than nothing."
"But the republicans (insert insult here)
" The free market..."
"Oh that's too hard"
"We already know what to do..."
Well...
Better than nothing sometimes isn't. Wasting opportunities to address only a part of something inadequately isn't better. It's tragic.
"But the Republicans..." When did Obama and the Democrats give a crap about them? When it wanted the mandate it shoved it down nicely, but not the same people are afraid to foster rational foresight put into action which can stand on it's merits? Shame on them.
"The free market". The free market will eat you and spit you out. It will take your retirement for buyouts. It will outsource your job or replace you for one more black line on the ledger, if the red ink it incurs is made from your blood. Only a fool begs a dollar sign.
"We already know". No we don't. We may have sufficient data and means to gather more, but no one has proposed a unified plan of reform from beginning to end with regulatory and Constitutional issues taken into considerations. Yet people who do not have the time to begin to understand the issues much less become sufficiently informed to deal with them are seen as the fount of all wisdom, qualified to lead. No, they are not. They are legally tasked to pass legislation, but they do not have to be in charge of how we get from point A to B. They can delegate that to others THEN act on enlightened proposals.
Government in the proper context CAN do good things, but some they cannot. They can create opportunities for others to do expert work. They can be enablers, facilitators. They suck as doctors. They can create the means by which others lead us to the Moon, but they aren't qualified to tell others how to get there. They can fund wonderful institutions like the CDC or the NIH. They can do the same for academia with research into the sciences. Health care? No let the politicians do it because we can't trust the best people? What kind of sane policy is that? Doing so would take too long, but the debate over what we were told we could has consumed too much time and effort instead. How does that help? And when people finally (too late no doubt) get it, they will have to work around the ACA to get where we need to be, because there are those who would see the nation burn before admitting it needs to go and the world would need to burn to remove it's entrenched roots.
The ACA and indeed the call for socialized medicine or UHC is irrelevant if it is all to produce garbage. Sweden? We can't do much better politically than some African governments and yes that includes the "we know everything" Democrats as much as the "Huh, did you say something?" Republicans.
So the answer is that the ACA "isn't harmful" directly. It's the wrong bandage to treat a fatal illness that will only get marketer mentality to treat.
What could go wrong?