So, Florida, North Carolina and a bunch of other red states have managed to thwart the ACA ("obamacare," i.e. "warmed-over romneycare"). I have mixed feelings about that because while I wasn't thrilled with the plan, it would have been nice to be able to get SOME kind of insurance - "just in case." The unfortunate reality in America today is that you can lose EVERYTHING if you have a major accident or illness and are not insured, and sometimes even if you ARE insured, as my dad found out when despite having both Tricare (military insurance) AND a private insurance policy, my step-mom's [fatal] cancer "treatments" (and I use that term very loosely) ended up bankrupting him because the insurance didn't cover jack sh*t. That's the practical reality.
BUT - when you take a step back and look at "health insurance" as a concept, isn't it really just a big "Protection Racket"?! It's like gambling only in reverse: You know you can never WIN - that premium money is gone forever no matter how healthy you manage to stay - but you keep paying out the nose for fear that statistically, you MIGHT lose if/when catastrophic illness strikes!
Having worked in mainstream medicine for over 20 years, I myself avoid doctors like the plague, literally, but I used to have insurance "just in case" back in the early 2000s. The only way I was able to get covered, being so-called "self employed" (= employee without benefits, working for somebody else but paying the employer's share of the taxes) was simply because CFIDS was not specifically listed as a "condition" on the application for that particular insurance company and apparently they didn't look carefully at my records. I hardly ever saw a doctor, except to get birth control back when I needed it, but I kept paying, and the premiums kept going up every 6 months until in 2008 they were $400/month! I just could not do it anymore. Plus, with the deductible being like $6000+ (and that kept rising, too), it was just insane. For all practical purposes my "insurance" didn't cover anything, and if/when disaster might strike, the deductible would wipe me out anyway. After I dropped that insurance I was unable to get covered by any other company for any price, due to my preexisting condition, which by that time all the companies had added to their list of exclusions.
With premiums being so expensive, what are we really paying for, then? As a (old-school) libertarian, I'm all in favor of "free exchange of goods and services." But, when you think about it, insurance is neither a "good" nor a "service," it's a gamble. My doctor used to charge me around $50 for an office visit; I have no idea what they charge nowadays, not having set foot in a doctor's office since early 2008. At $400/month, that ought to cover like 8 visits - right? So where is all the $$ going??!! It's a huge f*ng scam. But what can you do? Disaster strikes, people get sick and medical bills can literally take your house. I don't think there's an easy answer given the existing status quo in our pharma-medical-industrial complex.
A couple of my conservative friends have suggested things like encouraging competition between the insurance companies by allowing people to buy insurance across state lines. At first that sounds kind of appealing - I would LOVE to be able to get Kaiser insurance again, which I had when I lived in California, it was very affordable and had low co-pays! Of course that was back in the 1980s. But, upon looking into this, I learned that "the experts" don't think it would actually solve our existing problems re: preexisting conditions, etc. In addition, there's the small matter of violating states' rights, because apparently the whole reason it's illegal to buy insurance across state lines is that each state currently has the right to manage insurance as they see fit within their own state, in case anybody cares.
I do like the idea (in theory) that competition would lower premiums, even though in fact the experts say it probably wouldn't, for most people, given that you need to have ZERO conditions of ANY kind to be considered "healthy" for insurance premium purposes. My CFIDS had been, thanks to holistic medicine, in complete remission for 12 years when I applied for new insurance; I was a yoga and pilates teacher, a vegetarian, a nonsmoker, with an ideal BMI, taking no medications and not having had any medical claims, ever, but it wasn't good enough, and without regulation to the contrary, it still wouldn't be no matter how much "competition" might ensue; the insurance companies would be "competing" for the young, healthy [men] with spotless medical records. The rest of us would still be SOL.
Let me just say up front that the ACA technically constitutes "fascism" - the collusion of government and industry. There's plenty of that going on already in Congress, of course, but the ACA brings it home for the average person. Basically the government is forcing us to buy private insurance, and then allowing the insurance companies to continue to screw us. So, they can now screw us with the government's blessing.
Having said that, I would have been ok with everybody just getting on Medicaid. Because, although the voter card in my wallet says I am a "Libertarian" (a label that makes me cringe now that the Tea Party has coopted it!!!), I really am NOT in favor of, e.g., privatizing the roads. Of course not! Have you ever driven in Orlando, Florida?! THAT is what privatized roads would be like: A nightmare maze of never-ending toll booths. I believe there may be some essential services that are in our collective best interest - our "enlightened self-interest," if you will - to be managed publicly: the roads, the military, the prisons, the mail, and maybe even health care, like every other civilized country does.
What?! Well, yes. Health care is something that everybody needs at one point or another, especially now that we have the technology to forcibly keep old people "alive" and prolong their misery long after their bodies want to quit, and/or bring little people into the world with horrible deformities requiring ongoing painful, expensive, halfway successful surgeries, whom God and/or Nature would have mercifully taken Home in simpler times. As technology advances, so does the mandate to use it, like it or not, and so does the cost. How do we pay for it?!
The problem with "for profit" healthcare is that healthcare by its very nature (at least in our allopathic system) involves taking care of sick people. And the only way that insurance companies can make a profit, which is their nature in a capitalist system, is to ensure that the intake of premiums $$ is greater than the outflow of benefits $$ paid; therefore, obviously, they want to insure healthy people who don't NEED to use the insurance benefits! That was, of course, the purpose of the "individual mandate" of the ACA - by expanding the pool of covered persons to include the young and healthy who might otherwise not bother, you could theoretically keep the premiums lower for everyone.
Except, of course, there's nothing to stop the insurance companies from raising their rates anyway, especially in states like FL and NC who have chosen, for some reason, to forfeit their state's right of Insurance Commissioner being able to regulate premiums. I have it on good authority that our wonderful governor Rick Scott, whose family enjoys the best healthcare available paid for by us, the humble working citizens, did so merely in order to say "FU" to the President, because apparently political snubs are more important to him than the health of Floridians who are paying his salary. No big surprise there, I suppose.
I don't know what the answer is, but I will continue my policy of staying the hell away from doctors as much as possible, relying on holistic/herbal medicine which isn't covered by insurance anyway, and just pray to God that nothing really serious or "catastrophic" ever happens that would result in my becoming homeless. But let's keep in mind that in America, having a home isn't a "right," it is a "privilege" - as some believe that healthcare also should be. And who am I to argue with them?