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Weighing the ACA
Plus Ça Change, ACA Edition

Despite a temporary bump, overall satisfaction with the quality of American health care is virtually the same now as it was in 2005-2007, and attitudes towards health care coverage and cost remain unfavorable, according to a new survey. Gallup breaks down the numbers:

From 2005 to 2007, a slim majority of Americans rated the quality of healthcare in the U.S. as excellent or good. But this percentage increased slightly in 2008 after President Barack Obama was elected, reaching a high of 62% in November 2010 and again in 2012 just after he was elected to his second term. Those higher ratings could reflect optimism about Obama’s promises to reform healthcare and the passage of the Affordable Care Act. However, since November 2013, shortly after the ACA insurance exchanges first opened, no more than 54% of Americans have rated the quality of healthcare in the U.S. as excellent or good.

Americans rate U.S. healthcare coverage far less positively than they do healthcare quality. The percentage of Americans rating U.S. healthcare coverage as excellent or good increased from 26% in 2008 to 38% in 2009. Since then, the percentage who view healthcare coverage in the U.S. positively has varied slightly from year to year, but remains higher than before Obama took office

Americans’ satisfaction with the total cost of healthcare in the U.S. remains low, with 21% saying they are satisfied. Twenty-eight percent were satisfied in 2001, but satisfaction fell after that, rising again only in 2009, to 26%. This increase too may reflect optimism about the possibilities of Obama’s healthcare reform. However, satisfaction has since slipped.

This is yet another piece of evidence that the Affordable Care Act hasn’t really done much to improve many Americans’ experience with the U.S. health care system. Whatever one can say about the ACA, it’s increasingly clear that it left intact many of the root dysfunctions driving our health care problems, and, as a result, Americans are still unhappy with both cost and coverage, and almost evenly split on quality.

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  • Andrew Allison

    Surely what’s significant is how the participants in ACA exchanges and those who choose not to participate feel. Seems pretty clear what those who are eligible and choose not to participate think, as does those complaining about not being able to afford care even though they have insurance. The fact that just 13% of the participants are not receiving taxpayer-funded subsidies is also significant. In short, don’t confuse the slow-motion train wreck that is ACA with overall health insurance.

  • ljgude

    Health outcomes in the US are on a par with the rest of the developed world. The difference is that it costs about twice as much for the same result. Sanders was right – the ACA is a good Republican law in the sense that it tries to accomplish reform through the private sector which already was running at 16% of GDP 1n 2009. Guess what happened. The private sector – the Hospitals, Doctors, HMOs, Insurance companies look after their rice bowls and the percentage of GDP rises to 17.5% of GDP which the authors of the bill clairvoyantly capped expenditure at through 2017. Like they were devious Republicans serving the vested interests. Here is one way to fix it. 1. Drop the medicare age gradually or all at once so that everyone gets covered, but don’t make it single payer. 2. Restructure the Insurance industry so people can buy the coverage they want beyond what they can count on from the public system – current Medigap type insurance is a small example of the proper role of health insurance. But the point is that the private system gets paid for by the people who can afford it and want it and that takes pressure off the public system so it doesn’t bog down in waiting lists and bureaucracy like the VA has. I’m an American long resident in Australia and our public system is far from bogged down and very very good. I pay for private insurance and get access to private hospitals and choose my specialists. That costs me AUD $1700 a year, not a month. If the insurance goes up too much people drop it and depend on the public system. If the waiting lists get too long for elective surgery they buy insurance. This is competition and it keeps costs down to about 10% of GDP for the same health outcomes. The medical industrial complex is conservatively rorting Americans 5% -7% of of a GDP of 18 trillion a year. There are people satisfied with this?

    • Dale Fayda

      Population of Australia – 22 million (less than Texas), population of USA 319 million. Population of Australia – 92% non-hispanic white, population of USA 62% non-hispanic white, with HUGE swaths of population more or less on the public dole. External debt of Australia – $1.3 trillion, external debt of USA – $18 trillion. USA now has an insurance market which is basically just another Federal government agency, grossly over-regulated and over-priced. Medicare and Medicaid are insolvent or nearly so. Social Security is insolvent or nearly so. Interest payments are the external debt about to become the 4th largest budget item of the Federal budget. I can put another dozen reasons why the Australian system wouldn’t work in the US, but I think you get the picture.

      The way to lower costs in the healthcare industry, as they are in every industry in creation, is to have less government involvement in it, not more. Medicare for all IS single payer. How can it be otherwise, if it’s a public system run by the Federal government? It’s a financial failure already, fewer and fewer providers want anything to do with it and it’s already blowing up the budgets of the states idiotic enough to along with its expansion under Obamacare. Personally, I refuse to be taxed for a public system which I don’t even want to go near AND also have to pay for private insurance, just so I may be seen by my doctor of choice in a timely fashion.

      Government control of anything brings scarcity, appalling waste and corruption, while the private sector brings price competition and abundance. Get the government out of healthcare and watch the costs drop. Fact.

  • MarkE

    How to lower cost, increase availability, and improve
    quality of US medical care.

    For insurance: let
    individuals rather than companies get the tax break for purchasing it, let all
    insurers compete in every region of every state (mostly they are oligopolies
    now), let poor people have Medicaid HMO like care with increasing ability for
    patients to make choices as they are increasingly able and do pay premiums.

    For hospitals: Let anyone build a hospital as long as it
    passes inspection, no more certificates of need which process has been captured
    by hospital lobbies to eliminate competition (yes, hospitals are also mostly
    oligopolies). “Non-profit” hospitals
    should pay the same taxes and conform to the same standards and regulations as
    for-profit hospitals (non-profits that make a profit are forced to spend it on
    uneconomic or anticompetitive projects and if they don’t make a profit they
    don’t have to be as efficient).

    For pharmaceutical companies: Repeal the part D agreement
    that the government can’t negotiate prices with Pharma. Make it legal for US
    citizens to buy prescription drugs from foreign countries so Pharma can’t make
    US citizens bear all the development costs for these drugs. The FDA should
    certify quality from foreign suppliers so US citizens (also foreigners) aren’t
    victimized by counterfeiters.

    For Doctors: Make medical liability no-fault with retraining
    or restriction of physician truly practicing poorly. Allow physicians to accept
    Medicare for some patients and some conditions, but not others. Make compliance with increasingly complex regulations
    no-fault with retraining or restriction if non-compliance can be shown to be a
    real problem (now they function as net of gotcha’s for anyone trying to apply
    common sense).

    • Dale Fayda

      Sounds eminently sensible. And the beauty part is that none of this costs the taxpayers anything or next to nothing, at worst.

    • iconoclast

      I would only add :

      – Prevent states from mandating coverage terms, such as requiring alternative medicine coverage. Let people who want such coverage request it.

      – Ensure that professional associations should be able to form their own groups and provide insurance nationwide. I am a member of two such groups, both of whom would be very happy to be able to provide group insurance at an excellent price.

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