Social policy today 601(2) state-regulated health insurance networks combined with public subsidies to
help pay for insurance for those who cannot afford it, and (3) market-based solutions
based on tax credits and flexible spending accounts. The first of these was quickly
rejected by Congress and is not likely to be implemented in the United States, despite
being the program of choice for nearly all other Western developed nations. Critics
dismiss single-payer plans as “socialized medicine” and point to the rationing of care
that often occurs under such programs. Similarly, market-based solutions, which
most Republicans supported, were rejected by Democratic leaders who believed
the approach would leave too many Americans uninsured. This approach has the
greatest potential for addressing the inflation of health care costs, but some health
care professionals argued that many people would lack the knowledge base necessary
to make the appropriate decisions concerning their own health care, because buying
health care is much more difficult than shopping for food, clothing, or other consumer
goods.
This left the middle ground between a single-payer plan and market-based
approaches. In the introduction to this chapter, we discussed the politics of how reform
passed. Here we summarize the main provisions, as it is impossible to discuss all the
details of the voluminous, more-than-2,000-page law that one reporter described as
“twice as long, and half as intelligible, as Tolstoy’s masterwork War and Peace.”^60Understanding the ACA (“Obamacare”) The president’s first goal—
comprehensive coverage—was essential. The problem had to be tackled as a whole.
If the law were to require insurance companies to cover people with preexisting
conditions without mandating that everyone have insurance, people would avoid
personal expense and wait until they were seriously ill before they purchased
any health insurance. To spread the costs of expensive care needed by those with
preexisting conditions and others, the law needed to mandate coverage for all, thus
“pooling” healthy people and young people with older and sick people. Comprehensive
coverage was achieved by requiring businesses with more than 50 employees to
provide coverage and by requiring all individuals without employer coverage to
purchase insurance through new state-regulated private health insurance exchanges,
which were implemented in 2014. Businesses and individuals who did not comply withProposed budgetary solutions
to Medicare and Social Security’s
unfunded liabilities involve politically
unpopular benefit cuts and tax
increases. To illustrate, Senator Bernie
Sanders stands behind 2 million
signatures asking Congress to reject
proposed cuts in 2013.Full_17_APT_64431_ch16_572-613.indd 601 16/11/18 11:28 AM