Republicans: what do you hate about Obamacare and what’s the solution?

[Doomer]

You guys are going to repeal is sooner or later now that McCain is gone.  But why do you hate it?  Do you even have a reason other than it came from Obama?  And what’s your best plan for replacing it?

[7,052,770]

You guys are going to repeal is sooner or later now that McCain is gone.

Since McCain saved it last summer, Alabama replaced a Republican senator with a Democratic one, so McCain's death just puts it back to 51 in favor of keeping it.

[Strudelcutie4427]

I just don’t like the tax increase and being required to buy “government approved plans” the worst part was the individual mandate, and since I’m a healthy 23 year old guy, I don’t need or want to buy health insurance. A good alternative would be to increase competition for both insurance companies and pharmaceutical to drive down the costs. It would also be better to work towards cure and prevention rather than treatment once the solutions become available

[Torie]

I guess a predicate question is whether one wants all (or legal residents) to have access to a reasonable level of medical care irrespective of the ability to pay. If so, then one can talk about how to effect that.

[Take your vitamins and say your prayers, Brother!]

I didn't hate Obamacare.  My main issue with Obamacare is that once the SCOTUS gutted many of it's provision, particularly the provision that included Medicaid Expansion, making it voluntary for the states, it became a system that was (A) going to leave many uninsured, (B) result in ever-escalating premiums with regular diminishment of coverage, and (C) would eventually collapse of its own weight as so many of those responsible for its maintenance wish to see it fail.

Obamacare was a work in progress when it was rolled out.  It seemed clear to me that it was a compromise solution to ensure healthcare coverage for as many as possible, and was something that would need tinkering and adjustment going forward.  That can only be possible, however, when the Congress is not bent on sabotaging that solution.  The GOP has made no secret; they don't want Obamacare to work.  They want it to fail; that it was THEIR idea in the first place means nothing.  They simply won't fix it.  They're like a stubborn spouse who won't fix their wife's car because she bought it herself, without conversing with her husband, and she knew it would need repairs and maintenance, but the husband isn't committed to that new clutch (so she'll ride it with difficulty shifting until it stops) or a starter that requires banging on it with a wrench until the day when the car just won't turn over.

I'm not a "small government" Republican.  I have come to view the Freedom Caucus folks as the reason that we can't have nice things if they're not tax cuts.  Healthcare is one of them.  These people will sabotage single payer if it were created.  Perhaps a better strategy for the Democrats (as opposed to this silly 'Resstance" that represents the height of self-indulgence) would be to focus on Healthcare in such a way that causes the Freedom Caucus to be seen as persons who don't care if Americans who are not middle class or above suffer unnecessarily from disease and injury, and die before their time.  The smug snot-noses like Jim Jordan will not be moved, but other, more reasonable Republicans might actually be shamed into movement (Chris Smith of NJ comes to mind.) if the point were made forcibly enough, and didn't get lost in other arguments about how Trump's a Poo Poo Head.  Indeed, Trump might actually be the one to break the deadlock on this issue, but, as of nos, the Democrats are conducting themselves in a way to which this will never be possible.

[elcorazon]

I just don’t like the tax increase and being required to buy “government approved plans” the worst part was the individual mandate, and since I’m a healthy 23 year old guy, I don’t need or want to buy health insurance. A good alternative would be to increase competition for both insurance companies and pharmaceutical to drive down the costs. It would also be better to work towards cure and prevention rather than treatment once the solutions become available

1. I don't want to pay more taxes (Is there a tax increase in Obamacare?)
2. I don't want to have the government tell me what kind of plan I have to have - do you mind that liability insurance is required to drive a car? what about health requirements in restaurants - why should they have to follow government safety rules? should we have anarchy?
3. I don't need or want health insurance - you better hope you don't. I wish you well and good health but if you have an accident or illness, do you want the health system to say, hey you made your choice not to participate so if you can't afford it, you don't get treatment for your cancer or even your broken bones? If you say they should still treat you, then aren't you a freeloader?
The last bit is plattitudes - driving down costs is one of the theories of the Affordable Care Act before the Republicans gutted the thing. sigh.

[Dabeav]

Simply it jacked up costs of insurance for the middle class (by a lot for some, or a big loss in benefits)for some basic services for the bottom 10%.  It wasn't a good solution or trade-off.

[Take your vitamins and say your prayers, Brother!]

I just don’t like the tax increase and being required to buy “government approved plans” the worst part was the individual mandate, and since I’m a healthy 23 year old guy, I don’t need or want to buy health insurance. A good alternative would be to increase competition for both insurance companies and pharmaceutical to drive down the costs. It would also be better to work towards cure and prevention rather than treatment once the solutions become available

This, of course, is horse manure.  To be kind.  The reason for this is that 23 year olds like this person are not going to purchase health insurance at any price.

What IS "health insurance"?  It's taking money from people who are healthy and giving it to people who are sick.  That's what it is, period, when you boil all else off.  Being "competitive" requires the input of resources from health people who will not be expecting to avail themselves of the benefits anytime soon, until something bad happens that was totally unexpected.

I always viewed it as my responsibility to provide health insurance for myself, and for my family.  I also don't see why it shouldn't be everyone's responsibility to kick into the pool, just as they do with police and fire protection.  I will tell you from longitudinal experience that it's those who took this kind of position at 23 that I've known over the years that are the biggest whiners about Medicare preimiums now that they have grown old.  That, by the way, was one of the most insidious attacks Mitt Romney made; trying to frame the Obamacare argument as one that was giving working class families healthcare at the expense of Medicare and seniors.  I was amazed as to how little flak Romney got for that one.

[Nyvin]

Simply it jacked up costs of insurance for the middle class (by a lot for some, or a big loss in benefits)for some basic services for the bottom 10%.  It wasn't a good solution or trade-off.

If you're middle class, chances are you get insurance through your employer.

[Strudelcutie4427]

I just don’t like the tax increase and being required to buy “government approved plans” the worst part was the individual mandate, and since I’m a healthy 23 year old guy, I don’t need or want to buy health insurance. A good alternative would be to increase competition for both insurance companies and pharmaceutical to drive down the costs. It would also be better to work towards cure and prevention rather than treatment once the solutions become available

1. I don't want to pay more taxes (Is there a tax increase in Obamacare?)
2. I don't want to have the government tell me what kind of plan I have to have - do you mind that liability insurance is required to drive a car? what about health requirements in restaurants - why should they have to follow government safety rules? should we have anarchy?
3. I don't need or want health insurance - you better hope you don't. I wish you well and good health but if you have an accident or illness, do you want the health system to say, hey you made your choice not to participate so if you can't afford it, you don't get treatment for your cancer or even your broken bones? If you say they should still treat you, then aren't you a freeloader?
The last bit is plattitudes - driving down costs is one of the theories of the Affordable Care Act before the Republicans gutted the thing. sigh.

1. Yes there was an increase in the taxes. Either for O-care or medicate expansion.
2. In NH you don’t need car insurance, so I don’t
3. If I get hurt that’s on me. It’s no one else’s fault unless they caused it. I haven’t been sick in years, and although I have had skin lesions, My friends mom is a dermatologist and she took care of those at home

[elcorazon]

I just don’t like the tax increase and being required to buy “government approved plans” the worst part was the individual mandate, and since I’m a healthy 23 year old guy, I don’t need or want to buy health insurance. A good alternative would be to increase competition for both insurance companies and pharmaceutical to drive down the costs. It would also be better to work towards cure and prevention rather than treatment once the solutions become available

1. I don't want to pay more taxes (Is there a tax increase in Obamacare?)
2. I don't want to have the government tell me what kind of plan I have to have - do you mind that liability insurance is required to drive a car? what about health requirements in restaurants - why should they have to follow government safety rules? should we have anarchy?
3. I don't need or want health insurance - you better hope you don't. I wish you well and good health but if you have an accident or illness, do you want the health system to say, hey you made your choice not to participate so if you can't afford it, you don't get treatment for your cancer or even your broken bones? If you say they should still treat you, then aren't you a freeloader?
The last bit is plattitudes - driving down costs is one of the theories of the Affordable Care Act before the Republicans gutted the thing. sigh.

1. Yes there was an increase in the taxes. Either for O-care or medicate expansion.
2. In NH you don’t need car insurance, so I don’t
3. If I get hurt that’s on me. It’s no one else’s fault unless they caused it. I haven’t been sick in years, and although I have had skin lesions, My friends mom is a dermatologist and she took care of those at home

so as long as you have a friend who can help you out, no need for government to get involved. [Schadenfreude comment deleted - Torie]

[RINO Tom]

Obamacare was specifically designed as a placeholder to create a demand for government-run healthcare.  It's sort of a "worst of both worlds."  One example is that the cost of providing health insurance to employees for some companies is much higher than the fine they would pay for not offering it ... that is obviously going to eventually create a void that the government would fill.  At that point, the issue becomes how expensive such an undertaking would be for the federal government, and we all know it would be paid for with large tax increases that I think would have other negative effects on the economy.  However, if you want to go more toward single-payer, just come out and say it.  Obamacare appears a sly push in that direction.

[Lechasseur]

I didn't hate Obamacare.  My main issue with Obamacare is that once the SCOTUS gutted many of it's provision, particularly the provision that included Medicaid Expansion, making it voluntary for the states, it became a system that was (A) going to leave many uninsured, (B) result in ever-escalating premiums with regular diminishment of coverage, and (C) would eventually collapse of its own weight as so many of those responsible for its maintenance wish to see it fail.

Obamacare was a work in progress when it was rolled out.  It seemed clear to me that it was a compromise solution to ensure healthcare coverage for as many as possible, and was something that would need tinkering and adjustment going forward.  That can only be possible, however, when the Congress is not bent on sabotaging that solution.  The GOP has made no secret; they don't want Obamacare to work.  They want it to fail; that it was THEIR idea in the first place means nothing.  They simply won't fix it.  They're like a stubborn spouse who won't fix their wife's car because she bought it herself, without conversing with her husband, and she knew it would need repairs and maintenance, but the husband isn't committed to that new clutch (so she'll ride it with difficulty shifting until it stops) or a starter that requires banging on it with a wrench until the day when the car just won't turn over.

I'm not a "small government" Republican.  I have come to view the Freedom Caucus folks as the reason that we can't have nice things if they're not tax cuts.  Healthcare is one of them.  These people will sabotage single payer if it were created.  Perhaps a better strategy for the Democrats (as opposed to this silly 'Resstance" that represents the height of self-indulgence) would be to focus on Healthcare in such a way that causes the Freedom Caucus to be seen as persons who don't care if Americans who are not middle class or above suffer unnecessarily from disease and injury, and die before their time.  The smug snot-noses like Jim Jordan will not be moved, but other, more reasonable Republicans might actually be shamed into movement (Chris Smith of NJ comes to mind.) if the point were made forcibly enough, and didn't get lost in other arguments about how Trump's a Poo Poo Head.  Indeed, Trump might actually be the one to break the deadlock on this issue, but, as of nos, the Democrats are conducting themselves in a way to which this will never be possible.

I agree with everything Fuzzy Bear just said here.

[Nyvin]

Simply it jacked up costs of insurance for the middle class (by a lot for some, or a big loss in benefits)for some basic services for the bottom 10%.  It wasn't a good solution or trade-off.

If you're middle class, chances are you get insurance through your employer.

...and chances are also good that you are paying a portion of your premiums and making copayments at the point of service, both of which have continued to increase dramatically since the ACA's passage. You might also be one of a growing portion of employer-insured Americans who are enrolled in high-deductible plans.

There's also some chance that you will be hit by the 40% tax on high-cost insurance plans. That's if it is ever actually implemented; it's most likely that it won't be, as strong interest groups within both parties hate it. Cost growth in health care has been strong enough that this would affect a much larger share of the US population than the law's designers led both the public and legislators to believe.

Of course, as Jonathan Gruber made headlines for saying several times, the sales pitch behind the law, and the Cadillac tax specifically, was crafted with "the stupidity of the American voter" in mind.

I'm in one of the most expensive states in the country,  and my health insurance through my employer cost me $87 a month, which is taken pre-tax, and my deductible is $750 per year.

I can afford whatever increases the ACA has caused (if any).

[Progressive Pessimist]

Because Obama initiated it. It's that simple. Dole and Romney proposed/accomplished almost the exact same damn thing!

[All Along The Watchtower]

Because Obama initiated it. It's that simple. Dole and Romney proposed/accomplished almost the exact same damn thing!

I hope you realize that this does not reflect well on the ACA.

[TPIG]

There are many reasons I dislike Obamacare and want to see it fully repealed and replaced with a sweeping, free-market driven reform plan.

First, there's the individual mandate. It's a massive violation of personal freedom to force individuals to purchase health insurance that they either don't want or can't afford or be forced to pay a stiff penalty. Whether or not it's technically a tax, people shouldn't be forced to pay up for NOT buying something.

Secondly, there's the employer mandate. To force businesses above 50 employees to provide health insurance, both represents a death knell to many small businesses and keeps other, even smaller businesses from being able to expand because they want to avoid the 50 employee threshold. There's ample evidence that this has occurred:

https://www.marketwatch.com/story/businesses-eliminated-hundreds-of-thousands-of-full-time-jobs-to-avoid-obamacare-mandate-2017-11-24

Thirdly, it was predicated on a false promise of allowing people who had plans that were below Obamacare standards to be able to keep their plans. Obviously, that turned out not to be true, and millions of Americans lost their health insurance because of it.

Finally, it made healthcare more expensive as it dramatically increased demand for health insurance while restricting supply through things like the medical device tax and other regulations. The Affordable Care Act is anything but affordable, and the country deserves better.

[Progressive Pessimist]

Because Obama initiated it. It's that simple. Dole and Romney proposed/accomplished almost the exact same damn thing!

I hope you realize that this does not reflect well on the ACA.

Well, there was a reason why Obama went with a plan similar to it. His hands were tied by congressional Republicans and conservative-moderate congressional Democrats. He, justifiably, didn't expect that it suddenly would have been too far-left for them. His goal was to improve health care in the country, and he succeeded even if it was through a flawed plan. That's what I appreciate in a leader is the ability to accomplish something meaningful, even if it will one day need to be expanded upon.

[Take your vitamins and say your prayers, Brother!]

There are many reasons I dislike Obamacare and want to see it fully repealed and replaced with a sweeping, free-market driven reform plan.

First, there's the individual mandate. It's a massive violation of personal freedom to force individuals to purchase health insurance that they either don't want or can't afford or be forced to pay a stiff penalty. Whether or not it's technically a tax, people shouldn't be forced to pay up for NOT buying something.

Secondly, there's the employer mandate. To force businesses above 50 employees to provide health insurance, both represents a death knell to many small businesses and keeps other, even smaller businesses from being able to expand because they want to avoid the 50 employee threshold. There's ample evidence that this has occurred:

https://www.marketwatch.com/story/businesses-eliminated-hundreds-of-thousands-of-full-time-jobs-to-avoid-obamacare-mandate-2017-11-24

Thirdly, it was predicated on a false promise of allowing people who had plans that were below Obamacare standards to be able to keep their plans. Obviously, that turned out not to be true, and millions of Americans lost their health insurance because of it.

Finally, it made healthcare more expensive as it dramatically increased demand for health insurance while restricting supply through things like the medical device tax and other regulations. The Affordable Care Act is anything but affordable, and the country deserves better.

This begs a question, however:  Is the RICHEST nation on Earth truly worthy of being called the GREATEST nation on Earth if it has the resources to take care of its people, medically, without persons sinking into bankuptcy because someone in their family drew the Cancer Card in the game of Life?  Are we a GOOD nation when we allow people to go through life with unset broken bones because they can't afford the orthopedic consult (let alone orthopedic treatment)? 

Freedom and Liberty is, very much, dependent on the decency and goodness of people.  Government intrusion is a by-product of the unwillingness of people to be decent.  The Civil Rights Laws of the 1960s did, in fact, reduce "freedom" and "choice" in certain areas, but that was because a massive swath of people would not be decent on the issue of racial discrimination in ways that allow oeople to function in everyday society without an intrusive, heavy-handed government MAKING them.  Sexual harassment laws restrict people's ability to make crude comments in the workplace, and imposes political correctness that many find stifling, but it's happened because the alternative was women legitimately feeling emotionally unsafe in the workplace.  Affirmative action is repulsive at certain levels because it implies a sort of quota system, but it became necessary because corporate employers, who held the key to entry to the middle class, would not be fair in hiring.  (A friend of mine's brother in law was a VP of a major bank in charge of management recruiting, and he told us, back in the 1970s, that his marching orders were to not hire any black or Puerto Rican candidates for branch manager trainees unless their qualifications were so overwhelming that there was no way to avoid this.) 

Is economic justice part of this?  Healthcare isn't whether or not someone has the right to a new car or even home ownership; it's the ability to receive help to stay alive and fight disease, or to reduce or minimize conditions that cause debilitating pain.  To what level must people suffer due to  disease and injury.  To what degree must their health depend on their good fortune or the fact that they are likable or well-connected?  I don't have any doctor friends, and with my luck, they'd be gynecologists (which would  be great for Mrs. Fuzzy, but not for me).  I'm not talking about abortion or plastic surgery here; I'm talking about cancers and broken bones, and stuff people need to live life well enough to function.  If conservatives believe that healthcare is merely something nice if you can afford it, or if someone is willing to be your Fairy Godfather/Godmother, then let them have the intellectual honesty to say just that, and let that sink in.

[Lechasseur]

There are many reasons I dislike Obamacare and want to see it fully repealed and replaced with a sweeping, free-market driven reform plan.

First, there's the individual mandate. It's a massive violation of personal freedom to force individuals to purchase health insurance that they either don't want or can't afford or be forced to pay a stiff penalty. Whether or not it's technically a tax, people shouldn't be forced to pay up for NOT buying something.

Secondly, there's the employer mandate. To force businesses above 50 employees to provide health insurance, both represents a death knell to many small businesses and keeps other, even smaller businesses from being able to expand because they want to avoid the 50 employee threshold. There's ample evidence that this has occurred:

https://www.marketwatch.com/story/businesses-eliminated-hundreds-of-thousands-of-full-time-jobs-to-avoid-obamacare-mandate-2017-11-24

Thirdly, it was predicated on a false promise of allowing people who had plans that were below Obamacare standards to be able to keep their plans. Obviously, that turned out not to be true, and millions of Americans lost their health insurance because of it.

Finally, it made healthcare more expensive as it dramatically increased demand for health insurance while restricting supply through things like the medical device tax and other regulations. The Affordable Care Act is anything but affordable, and the country deserves better.

This begs a question, however:  Is the RICHEST nation on Earth truly worthy of being called the GREATEST nation on Earth if it has the resources to take care of its people, medically, without persons sinking into bankuptcy because someone in their family drew the Cancer Card in the game of Life?  Are we a GOOD nation when we allow people to go through life with unset broken bones because they can't afford the orthopedic consult (let alone orthopedic treatment)? 

Freedom and Liberty is, very much, dependent on the decency and goodness of people.  Government intrusion is a by-product of the unwillingness of people to be decent.  The Civil Rights Laws of the 1960s did, in fact, reduce "freedom" and "choice" in certain areas, but that was because a massive swath of people would not be decent on the issue of racial discrimination in ways that allow oeople to function in everyday society without an intrusive, heavy-handed government MAKING them.  Sexual harassment laws restrict people's ability to make crude comments in the workplace, and imposes political correctness that many find stifling, but it's happened because the alternative was women legitimately feeling emotionally unsafe in the workplace.  Affirmative action is repulsive at certain levels because it implies a sort of quota system, but it became necessary because corporate employers, who held the key to entry to the middle class, would not be fair in hiring.  (A friend of mine's brother in law was a VP of a major bank in charge of management recruiting, and he told us, back in the 1970s, that his marching orders were to not hire any black or Puerto Rican candidates for branch manager trainees unless their qualifications were so overwhelming that there was no way to avoid this.) 

Is economic justice part of this?  Healthcare isn't whether or not someone has the right to a new car or even home ownership; it's the ability to receive help to stay alive and fight disease, or to reduce or minimize conditions that cause debilitating pain.  To what level must people suffer due to  disease and injury.  To what degree must their health depend on their good fortune or the fact that they are likable or well-connected?  I don't have any doctor friends, and with my luck, they'd be gynecologists (which would  be great for Mrs. Fuzzy, but not for me).  I'm not talking about abortion or plastic surgery here; I'm talking about cancers and broken bones, and stuff people need to live life well enough to function.  If conservatives believe that healthcare is merely something nice if you can afford it, or if someone is willing to be your Fairy Godfather/Godmother, then let them have the intellectual honesty to say just that, and let that sink in.

You're absolutely right again, Fuzzy.

Yeah, my honest belief is if the GOP struggles so much now, I really think to a large degree it's due to them being ridiculous on this healthcare issue (I know people who support the Democratic Party just over this healthcare issue).

[TPIG]

There are many reasons I dislike Obamacare and want to see it fully repealed and replaced with a sweeping, free-market driven reform plan.

First, there's the individual mandate. It's a massive violation of personal freedom to force individuals to purchase health insurance that they either don't want or can't afford or be forced to pay a stiff penalty. Whether or not it's technically a tax, people shouldn't be forced to pay up for NOT buying something.

Secondly, there's the employer mandate. To force businesses above 50 employees to provide health insurance, both represents a death knell to many small businesses and keeps other, even smaller businesses from being able to expand because they want to avoid the 50 employee threshold. There's ample evidence that this has occurred:

https://www.marketwatch.com/story/businesses-eliminated-hundreds-of-thousands-of-full-time-jobs-to-avoid-obamacare-mandate-2017-11-24

Thirdly, it was predicated on a false promise of allowing people who had plans that were below Obamacare standards to be able to keep their plans. Obviously, that turned out not to be true, and millions of Americans lost their health insurance because of it.

Finally, it made healthcare more expensive as it dramatically increased demand for health insurance while restricting supply through things like the medical device tax and other regulations. The Affordable Care Act is anything but affordable, and the country deserves better.

This begs a question, however:  Is the RICHEST nation on Earth truly worthy of being called the GREATEST nation on Earth if it has the resources to take care of its people, medically, without persons sinking into bankuptcy because someone in their family drew the Cancer Card in the game of Life?  Are we a GOOD nation when we allow people to go through life with unset broken bones because they can't afford the orthopedic consult (let alone orthopedic treatment)? 

Freedom and Liberty is, very much, dependent on the decency and goodness of people.  Government intrusion is a by-product of the unwillingness of people to be decent.  The Civil Rights Laws of the 1960s did, in fact, reduce "freedom" and "choice" in certain areas, but that was because a massive swath of people would not be decent on the issue of racial discrimination in ways that allow oeople to function in everyday society without an intrusive, heavy-handed government MAKING them.  Sexual harassment laws restrict people's ability to make crude comments in the workplace, and imposes political correctness that many find stifling, but it's happened because the alternative was women legitimately feeling emotionally unsafe in the workplace.  Affirmative action is repulsive at certain levels because it implies a sort of quota system, but it became necessary because corporate employers, who held the key to entry to the middle class, would not be fair in hiring.  (A friend of mine's brother in law was a VP of a major bank in charge of management recruiting, and he told us, back in the 1970s, that his marching orders were to not hire any black or Puerto Rican candidates for branch manager trainees unless their qualifications were so overwhelming that there was no way to avoid this.) 

Is economic justice part of this?  Healthcare isn't whether or not someone has the right to a new car or even home ownership; it's the ability to receive help to stay alive and fight disease, or to reduce or minimize conditions that cause debilitating pain.  To what level must people suffer due to  disease and injury.  To what degree must their health depend on their good fortune or the fact that they are likable or well-connected?  I don't have any doctor friends, and with my luck, they'd be gynecologists (which would  be great for Mrs. Fuzzy, but not for me).  I'm not talking about abortion or plastic surgery here; I'm talking about cancers and broken bones, and stuff people need to live life well enough to function.  If conservatives believe that healthcare is merely something nice if you can afford it, or if someone is willing to be your Fairy Godfather/Godmother, then let them have the intellectual honesty to say just that, and let that sink in.

I absolutely believe that in order for a nation to remain great, we have to have a healthcare system that allows people to receive quality treatment that doesn't also bankrupt them at the same time. I feel as though both of those elements are essential, and in order to achieve both, the system we want to pursue is not one of greater government intervention, price controls, rationing, increased waiting times, lower quality care, and worse health outcomes. I genuinely believe that the best way to help the poor in this country is to have a system of greater transparency, competition, choice, and freedom. This will make care more affordable, more effective, and make our entire country healthier.

The greatest asset the left has on this issue is the moral mandate. Who on Earth could be so heartless as to say, no healthcare isn't a right but rather a privilege that you either afford or don't? Well, to me, the outcome of the policy is far more important than the stated goal of a policy. Declaring healthcare a right does not magically make care more plentiful, effective, or cheap. In fact, because of many of the price controls and lack of profit incentive associated with socialized medicine, care becomes MORE scarce, LESS effective, and society's poor may be able to label themselves as insured  but in reality have very little access to good care. 

This is an important issue to me because, through family experience, I know what it's like to be hit with absurdly high medical bills. I also know that for the past 50 years, the Federal Government has been the main driver of healthcare inflation through increased regulation, and spending on healthcare while simultaneously restricting its supply. We have to look at the source of our problem and try to reverse it. I want all Americans to have access to quality, affordable, dependable care, and in order for that to happen, socialized medicine cannot be the answer.

[🐒Gods of Prosperity🔱🐲💸]

I hate a lot of things about it so I'll start with what I like:
It stopped insurers from being able to discriminate against those with pre-existing conditions. And it enabled a lot of people to be able to have insurance that didn't before.

That's enough for me to not want to get rid of it, or replace it with anything resembling the replacements the Republicans in Congress tried to get passed last year.

But there are huge problems with it.

I never liked the mandate to purchase insurance, always rubbed me the wrong way. I understand why it was part of the bill, but there's got to be better ways of encouraging people to get covered that don't cut against so many Americans' basic sense of freedom, with the govt telling them they have to buy something they can barely afford. For instance I think it would work pretty well if the insurance subsidies were made more generous so that everyone gets some level of tax credits for it even at higher income levels. Of course, that would mean there would have to be more revenue, and raising taxes is always difficult - which is why the taxes raised to pay for the ACA were not a single big tax but scattered among different mechanisms in hopes most people wouldn't notice a big change.

Regulations on providers, encouraging hospital consolidation and other things meant to improve efficiency like mandating electronic records.  But providers are already doing most of these things, since they don't want their costs to be more than necessary, even things that may be ultimately counterproductive.  In modern capitalism you rarely have to incentivize Taylorism for it to occur, but you can dubiously accelerate it.

Employer mandates, as has been mentioned.

Medicaid expansion: It makes sense for states to expand Medicaid in one way or another, given current circumstances and options available to get people care, and it's unjust for someone to be too *poor* to qualify for govt help (as the situation created by the law in states that haven't expanded) - but this aspect is a real mess. If you want to lower insurance prices, you generally want to expand the pool of people with private insurance. But with the ACA, the majority of the new people having health insurance is from Medicaid. This tends to raise private insurance cost instead, as providers raise prices in order to recoup losses from the lower Medicaid reimbursement rate.

And I don't like the power that this gave to HHS to set requirements, which allowed the Obama administration to do things like the contraceptive mandate and create a culture war issue without it even being debated in Congress. The claim made in favor of the birth control mandate was this would "save money" - again, the idea that companies can't even be trusted on their own to know how to  make a profit and have to be told by the government.  Meanwhile other regulations have contributed to fewer and fewer insurance options available on the market.

I've been thinking something along these lines as a good health care system we should move toward:

*Universal catastrophic coverage.

*Health savings accounts created for each person, with subsidized funds for those with little income.  These funds could be used either for supplemental insurance, subscribe to a health care organization or guild, or pay directly to providers.   

*No discrimination against those with pre-existing conditions, but otherwise providers and insurance companies would be much less tightly regulated. Insurance companies would have to be more competitive in how well they serve patients, as patients have more options to decide instead to pay out of pocket thanks to their health accounts and being already covered for catastrophic illness and injury.

*Lower drug costs by reforming patents, so that drug formulas are licensed out rather than being  monopolized in their production for so many years.

I'm sure there's some problems with this idea, and taxes would have to be raised considerably, but not nearly as much as with a quality single-payer program. Overall it could give both patients and providers more freedom and less bureaucracy from underneath insurance companies and the government, while controlling costs through the free market.