From a healthcare consumer perspective, it increasingly strikes one that the healthcare insurance market is a story of haves and have-nots.
The haves include those that work for companies of a certain size, at which the companies can access insurance at very expensive but somewhat rationalized costs (think $16,000 to $20,000 per family per year, with employees contributing roughly $5,500), people on Medicare, and — crazily enough — people on Medicaid. (Again, the concept of a "have" here solely relates to the availability of healthcare coverage. It is by no means meant to understate the challenge of being in such poverty to be eligible for Medicaid.)
The have-nots include a vast number of people trying to buy insurance directly from insurance companies. Here, one increasingly hears that whether one is rich or poor, the costs are horrendous. Family costs for PPO plans seem to fall in the $20,000 to $25,000 range for many families, and even higher for those with preexisting conditions.
From a provider perspective, Medicare is a mixed bag depending on the type of provider. From a hospital's perspective, it seems to be fine overall. From a physician's perspective, many seem to find it woefully inadequate.
One of the great challenges of the ACA is it set up an additional healthcare system of subsidies around insurance markets, mandates and so forth. It added complexity and costs, but also helped provide an additional basket of coverage for a good deal of uninsured Americans.
Regardless of political perspectives, rather than building another healthcare finance system, it seems that a simple approach would be to build on an existing system that, while imperfect, seems to work fairly well.
As an ardent capitalist at heart, the idea over the years of expanding a government program of any sort, including Medicare, has always led me to a negative conclusion. I.e., would it cause the kind of regression in our healthcare system that exists in systems in England or Canada, where care is famously inadequate or requires waiting months for certain types of care?
In contrast, at some point, does the cost of healthcare for those who don't work for a large company and aren't eligible for Medicare or Medicaid make the system so expensive that there is good reason to offer a Medicare option for such people? This demographic makes up a large part of the population, and it seems that the private insurance market is offering them only very expensive choices for health plans.
Much of my sense of the cost of private healthcare insurance comes anecdotally — from listening to diverse family and extended family around the Thanksgiving table, for instance. That stated, I do sense the cost of insurance for a family has moved from quite expensive to extremely and back-breakingly expensive. Sadly, I'm losing confidence that the core free market can fix it.