One of the more interesting gambits that played out in the health care debate was the ardent support for the Patient Protection and Affordable Care Act (ACA) by unions and large companies. Despite the fact that these organizations are particularly at risk from rising health care costs, the focus of the debate centered around the issue of expanding health care to the uninsured rather than reducing health care costs. Although the health care reform act is extraordinarily complex with many different cost containment ideas, the dominant idea is that we can lower health care costs by compelling all people to purchase health insurance. The crux of the argument is that by adding a few more health insurance customers the health care cost problem will magically go away.
I have a simple theory about controlling the rising health care costs. Although it is possible that a portion of the rising health care costs can be attributed to the uninsured, the majority of the health care costs for many years has been paid for by unions, large companies, and governments. Since these groups are the largest payers into the system, it follows that the actions and inactions by these organizations are the most likely causes of the increasing health care costs. Since they have the "gold" they are the group with most leverage to make rules to control costs. Although the health care reform act does attempt to reform this issue by taxing high cost plans and placing a cap on the tax benefit of employer-based health care insurance, these reforms have largely been offset by exemptions and delayed implementation.
The Patient Protection and Affordable Care Act (ACA) is a complex and controversial bill. There is no disagreement that this bill expands health care but the way we pay for the increased health care services is ambiguous. The polls in 2010 show that the average man and woman are skeptical that the cost containment ideas included in the bill will work. The elderly think the bill takes money away from them to expand services to the poor. The courts are skeptical that compelling an individual to purchase health insurance is constitutional. We are left with a bill that has a lot of ideas we may agree with in theory but not in practice. Maybe we need to heed to advice of Occam’s razor and replace this complex bill with a set of smaller, simpler bills that will stand up to the scrutiny of a town hall meeting.