Democrats dodged a monster magnum bullet when the ACA was found constitutional in a way that erased their fear that forgetting to include severability of the provisions would be fatal. However, another little act of absent-mindedness by Democrat lawmakers looms ahead and may be just as serious.
It all goes back to the intention of Pelosi, Reid, and Obama to make the ACA to appear as if it would be such a phenomenal reform that it would cost the US Treasury virtually nothing (and would not be a tax) and it would even save consumers money while protecting their right to see their old doctor and keep their old health care plan.
In order for all these good things to happen, particularly the projected un-necessity of tax hikes, it was assumed that (1) up to $800 billion dollars could be saved by reducing "unnecessary" medical costs. This was kind of code talk built on the assumption that doctors are paid way too much and medical schools are cranking out too many doctors. The Democrat remedy will assure that lawyers will be much more administratively involved in health care (because health care must be fair and only lawyers know those formulas) and therefore law schools can keep on cranking out record number of brand new lawyers. Cutting the salaries of doctors will be accomplished by radically slashing what Medicaid and Medicare reimburses them. (2) The second great financial savings that the Democrat Congress and White House counted on in 2009 was that the sheer cost of adding 30 million or so currently uninsured to the rolls of the insured would be picked up by the states.
The states would be required to create insurance exchanges where the mandated new consumers would be forced to go to purchase health insurance from private companies that will each be selling a virtually identical government-designed policy. Those who are unemployed will be covered by Medicaid which the states will have to pay for. Maybe. The Supreme Court left the door open for the states not to pay the Medicaid cost and many states may opt out of even starting an exchange altogether.The second huge mistake that the Democrat crafters of the ACA made in 2009 was that they absent-mindedly forgot to fund a way for the federal government to pick up these new Medicaid claimees if a state refuses to do so.
But let's go back a minute to how this looks to the uninsured people, who are often young and/or jobless, who have been heretofore getting by without medical insurance. In practice, for instance, young males who are very unlikely to develop prostate problems for a number of decades are going to not have the option to buy insurance that skimps on prostate examinations (which are of debatable effectiveness) or the pricey treatments (which are also of debatable effectiveness.)
The young males will be forced to buy a Cadillac health care plan that covers everything--contraception, abortions, mental health care, chiropractry, substance abuse rehab, all sorts of liberal must-haves, but also covers top rate spending on prostate problems. The cute trick here is that the young have been roped into a pool by the ACA so that they will be forced to pay for the prostate treatments of the old, especially the male baby boomers, who all have prostate trouble.
In a way, this is as clever a bit of big government deceit as social security itself. It is not like the excessive premiums that young males will be forced to pay for prostate coverage is going to go into an escrow account for when they finally need it. Oh no, the money they pay in is going out the door again immediately to pay for all the greedy old coots who will vote for Obama this November because the AARP told them they are going to make out like bandits.
But eventually the year 2040 will roll around and today's young people will be in for a big surprise. They watched for decades while Medicaid or Medicare paid or the new government-mandated Cadillac "private" plans paid for treatments that never seemed to result in real fixes but just went on and on for things like substance abuse or talk therapy for people who never improve mentally but really like it that the government has hired them a professional friend who has to listen to them complain about all that went wrong in their lives.
In 2040 it will be the turn of today's young workers to get theirs. They will look to the federal government for program after program that was created by lawmakers with the financial common sense of drunken sailors. Young folks, do you think that when you develop prostate issues or start losing your mind after menopause Obamacare will be there for you?
Our present system is guaranteed disastrous bankruptcy in many areas, and the ACA boils down to a big song and dance that will drag political mismanagement into the last major critical sector of private responsibility.