When trying to follow the conversation about the Affordable Care Act, it is important to stay focused and to judge the replacement ideas against a few fundamentals. If we agree that the country’s objective is the equitable distribution of health care to all individuals irrespective of their gender, age, caste, color, urban/rural location and social class (to paraphrase the World Health Organization, see references below) then we in the United States have to grapple with a fundamental fact: In a given year, 10% of the people incur about 2/3s of the health care costs. That’s about $54,000 for each of these people that year. The average for all Americans that year is about $10,800 each and the lowest 50% about $700 each that year. (See Dean Baker references below.) It is reasonable to assume that those in the 10% and probably many of those that have an average or above year are not able to afford these costs that year. America’s approach to this is to have some sort of insurance scheme. This then presents three interrelated dilemmas. All three have to be dealt with. It is like having a three-legged stool, to use a Paul Krugman analogy (see Paul Krugman references below). Not addressing all three will result in the plan falling over.
This is the Affordable Care Act: Community rating, mandatory insurance, and subsidies. It is important to stay focused and keep these fundamentals in front of us. How do the replacement ideas address these realities? References:
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