Austin Frakt wrote a post, “On what do health economists agree?”, that got me thinking about what most people agree about the Affordable Care Act. John Goodman beat me to the punch with his post, “I Edit Austin Frakt’s List”, but it still spoke generically about health care reform and not specifically about the Affordable Care Act. Health care reform is nice but the Affordable Care Act is law. So here’s my take on the provisions of the Affordable Care Act that both sides agree upon.

1. The employer mandate is a bad policy that was poorly implemented. Are there any conservatives arguing with Ezra Klein’s claim that the employer mandate shouldn’t be delayed, it should be repealed?
2. The individual mandate is a bad policy that was poorly implemented. The individual mandate is bad on so many levels it is hard to find someone willing to defend any part of it. Even its supporters are skeptical that it will work. So why do we continue with the charade? The success of the individual mandate hinges on convincing young, healthy people to buy health insurance they did not want when it cost half as much. If that wasn’t bad enough the IRS was chosen to enforce the law. This is a lethal political concoction. It is no surprise that poll after poll says the people hate the Individual Mandate. Undoubtedly the Affordable Care Act supporters would have a much easier time drumming up support for the rest of the law if the individual mandate would quietly disappear.
3. The cost for a bronze level health insurance plan is a lot closer the eHealthinsurance.com’s price than it is the price paid by large group plans. This revelation occurred when California posted the proposed prices for health insurance prices available on its health exchange. Kaiser Health News promptly changed their insurance cost estimator and the Roofer’s union had a panic attack. If an employer was paying  $15,022 for a family policy that your employee can get for $5,000 on the health exchange, what do you think an employer is likely to do? The Roofers have seen the future and they don’t like it. For states with high health insurance costs like Massachusetts, you have a problem!
4. Most people’s health insurance plans were better before the Affordable Care Act. Today I  heard Juan Williams complain on a Sunday morning talk show that Republicans did not have an alternative to the Affordable Care Act. Since most people are healthy and have health insurance, the Affordable Care Act has done little for them except increased their costs and anxiety. Sorry, Juan, my old plan was just fine and I would like to keep it just the way it was. The same goes for the Roofer’s union. The Affordable Care Act is merely a shell game with the health care funds for the people who are uninsured and chronically sick. All of this effort for a minimal decrease in the number of people without health insurance. Since most people are healthy they do not see a reform. Their only contact with health insurance reform is through how much they are paying for insurance and it continues to go up at the same pace. Maybe we should start treating the chronically and critically sick who do not have insurance as a health care spending problem rather than a problem that can be solved with more health insurance revenue.
5. Businesses want out of the health insurance business. When I started working in 1976 health insurance was an affordable employee benefit. For the employee it was so cheap you did not think about it. For the employer it was so cheap and simple to manage, they did not think about it either. In forty years it has gotten severely out of control. It has gotten so expensive that it poses a real risk to the business. It is not surprising that when small businesses feel threatened with health insurance risk they are resorting to their dropping health insurance plans or going to defined contribution plans.
6. All health care is local health care. The optimum health care plan involves your local doctor and hospital. How a federal plan, the Affordable Care Act, became the best option to accomplish this local health care goal confuses me. Like federal education programs it does seem to be the wrong tool for a local problem. There are alternatives. Here is an article by Sarah Kliff, Is this the end of health insurers?, describing a growing trend of health insurance being offered by local hospitals.
7. Health care cost accounting matters. It is hard to see an improvement in health care occurring without a tremendous improvement in cost accounting. Stephen pointed out the problem in his article, “ Bitter Pill: Why Medical Bills Are Killing Us”.