This is the dirty little secret that we are not supposed to talk about. Health Insurance is nothing but a wasteful, inefficient form of socialism. Republicans are trying to convince young healthy people that insurance is a bad deal, that in the aggregate, they will pay more in premiums than they will receive in benefits. And they are right!! In order for the insurance industry to turn a profit, they must rake in more in premiums than they pay out in claims. These repubs don't seem to understand how insurance works, or at least they are playing dumb. An insurance plan is a social contract. The members of the society (those paying premiums) have agreed to pay to protect everyone in the society from future misfortune. Without a government-run "socialist" health system, we rely on private insurers to administer our socialized medicine, adding cost in the form of profit and administrative costs.
In order for this profit to be anything but a horrendous waste of money, insurance companies must provide a cost saving benefit greater than the profit it extracts. Prior to the ACA, the practice of denying coverage and deciding which procedures were medically necessary did technically reduce costs (A long as you don't count death, suffering, and personal bankruptcies as costs). Even still, these cost saving methods were horribly inefficient, driving millions of people away from insurance and into the emergency room for the most expensive type of care.
When I was a "young healthy", I waited until I had a 103 degree fever and literally dragged my ass 1 mile to the nearest hospital. Extremely dehydrated and suffering from a severe case of strep throat, I was admitted, hooked up to IVs, and spent 3 days in the most expensive "hotel" in Pittsburgh (Shadyside Hospital). The bill was $18,500 (And this was 1997. I shudder to think what the damage would be today). The taxpayers of Pittsburgh and insurance policy holders split the bill. Socialism.
Follow me through the rabbit hole ...
The dirty secret is that we have always had socialized medicine. Society paid for my stupid decision to forgo preventative care and wait until the last second to visit the emergency room. Today, a portion of my health premiums are going to pay for the stupid decisions of today's young healthies. You see, the Republican plan to convince people to forgo coverage is brilliant. Health insurance is a bad deal because if you are uninsured and you get sick enough, society will pick up the bill. Its just like the way banks operate; private profit, socialized losses.
In order to push for the eventual single payer solution, we must make the socialized medicine argument. We have socialized medicine. We have always had socialized medicine. Why in the world are we wasting billions of dollars every year simply so we can delude ourselves into thinking we have a free market system. Once people learn that health care is a form of socialism, they will demand that we find the most efficient way to pay for healthcare for all. Single Payer.
The ACA is an important step in this direction. As the uninsured come online, costs will come down because the ACA pushes people toward using medicine more efficiently. The laws regarding the delivery of care will do more to bend the cost curve than anything the insurance industry has done in the past. Eventually people will recognize that given these regulations, the insurance industry is doing nothing except extracting massive profit from the system.
The result will be a popular push toward single payer.
Finally, In what should be mandatory for all diarists discussing the ACA, I will give a before/after summary of my family's health insurance situation.
My experience may not be typical as I am a graduate student in NY state (thus eligible for a student health plan). Also, due to a chronic illness, my wife incurs large prescription bills which far exceeded the meager $1,500 cap on prescriptions our plan used to have. The ACA did away with these piecemeal caps and replaced them with an omnibus $100,000 cap for essential benefits (which include prescriptions).
Before the ACA:
Premium (myself, spouse, 1 child): $4,800
Prescriptions (after $1500 per person per year cap): $7,500
Other out of pocket costs: $4,000
Total: $16,300
After the ACA
Premium: $2,500
Prescriptions: $1,200
Other out of pocket: $2,500
Total: $6,700
Well Damn.