As currently constituted, I have no idea, either.
Yes, the Affordable Care Act should help the poorest Americans to purchase health insurance, and to a lesser extent, middle-class people as well---but it's also going to screw over the youngs, the self-employeds, and the hourly-waged, who by themselves make up 75 million workers. That's a big fuckin' deal, wouldn't you say?
The big problem with the PPACA, as your humble blogger sees it, is that while it shifts health-care costs around---a lot to the government and to individuals, not as much to businesses---it doesn't do much to drive down the costs of a health-care system that is obscenely overpriced. Yes, we've heard about how the cost curve will be bent downward as soon as we get all of those able-bodied and healthy people enrolled along with the chronically ill, but we heard the same exact argument here in the Marxist dystopia when our legislature, in its wisdom, passed a mandatory auto-insurance law back in the '80s. A few antisocial cranks like Ralph Nader mumbled something about collusion and blank checks, but they were ignored by the serious persons of the time who assured us that market forces would solve everything as soon as both good drivers and bad drivers had some skin in the game---and no sooner had the law passed when premiums went through the roof for everyone. The voters got so enraged that, a couple of years later, they voted to create a state Insurance Commission to regulate the the industry and to approve rate increases----and one suspects that for the ACA to be truly successful as a cost-saving regime, the federal government will need to create some sort of Interstate Insurance Commission to set some basic standards for premiums, fees, co-pays, etc.
The irony, of course, is that the federal government already has a mechanism to set premiums, fees and co-pays. It's called Medicare, and it's a fairly efficient program. Perhaps in the future, our leaders would consider expanding a program that's proven it actually works instead of trying to fine-tune a program that, for most people, abysmally doesn't.
---Baron V
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