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There are a couple of important mechanisms in the Act which accomplish reducing overall cost.
First is the medical cost ratio provision which effectively mandates that a certain percentage of premiums collected need to be spent on providing care and benefits. This cuts out a lot of the administrative and marketing graft on the insurer level, and helps shift insurance companies away from a model in which consumer costs continue to double every five years or so. While it may hurt the short term bottom line, this provision will in the long run save the insurance industry, which if left unchecked would otherwise price itself out of viability in a decade while an increasing number of ostensibly middle class Americans went uninsured- the cost of their uninsured care further stacking onto premiums.
The second mechanism is the collective bargaining power of the government battling down prices. If I , get charged $10,000 for a medical procedure, I can't really argue. By myself, I can't wield power as a consumer since my opting to purchase (if I can even do so without dying) doesn't impact a provider's bottom line. But the government, which foots the bill for millions of patients and represents billions of dollars in revenue, has the ability to say what it will or will not pay for certain goods and services. And if a huge share of the market will only pay so much for goods and services, then the market will adjust to what people, or the government in this case, can afford. Some providers who can't adjust their model may go bust, but that's capitalism. Coddling providers whose business models can't survive prices resembling real supply and demand isn't the government's job. And it is in the interests of neither the consumer, nor the providers in the long term who on the current model would eventually price themselves out of business.
Granted, in the process of bargaining down medical costs there are going to be overlaps and gaps. There will be instances in which the government only pays $50 of a $100 bill, which providers can't bring lower without eating cost. And there are lots of supplemental programs already in place which cover these gaps- set up on reliable, stable revenue streams which leverage manageable premiums against the 20% not covered by medicare, while at the same time providing out of pocket caps which serve as a sort of fail safe for seniors' medical expenses. Most of these programs are more than adequate to cover the gap until the free market figures out what medical services are worth.
We do need to address entitlement spending, but the GOP plan is to simply transfer the cost to states and a smaller pool of people. It's exactly what Romney did so often in the private sector: don't actually fix the financial problems, just patch it over on paper until you can put it on someone else's balance sheet and walk away before the bill comes due, leaving other people to deal with the mess.
The problem? Romney's entire business model was premised on the carried interest loopholes in the tax code combined with on-paper-only losses as deductions and dumping remaining debt into someone else's pocket. With Bain, Romney just foisted the debt onto taxpayers and shareholders by having the companies go into bankruptcy and default on debts after taking out his fees.
Unfortunately, the federal government doesn't have the option of being a quasi-legal tax cheat and must actually provide services, which Bain never had to do, so his much-vaunted strategy and business acumen is useless.
Which brings us around to the election: exposure of this was starting to gain traction, so to avoid people taking a close look at his go-to tactics of how to 'turn businesses around' (and now presumably the government), and avoid having people looking too deeply at Ryan's lack of math skills, it's necessary to distort the issues. Hence the lying about the Medicare cuts under ACA and conveniently forgetting to mention that Ryan's plan cut more from Medicare--from the beneficiaries' side instead if the provider like ACA--but doesn't pay for it (ACA does through small--up to $40/year-- premium increases for certain high expenditure plans and through expanded private insurance reimbursements. In short, GOP advocates are lying about the 2 plans because if people hear accurate comparisons, they'll lose the election and they know it.
I do hope that it prompts entitlement reform--a grand bargain like the president floated 2 years ago which increases the retirement/eligibility ages by 2 years to account for increased life expectancy and raises taxes the necessary 3-4% on ALL income.
In this day and age, when we have some of the lowest tax rates in history, we can afford to do so if it means people won't have to pay wildly increasing medical costs from their own pocket, but instead can pool risk across the entire population, get care earlier (thereby miss less work later), and transition away from fee for service arrangements with no bargaining power.
Yeah, there's a lot to cover, but none of it will get addressed until the GOP is willing to put revenue on the table instead of the BS, long-debunked, trickle down tax cut religion they've been hanging onto insisting both that such tax cuts increase tax revenue while simultaneously asserting that they will also shrink government revenue. It's lunacy, but it works because two thirds of the electorate that elects them doesn't understand what they're saying and the remaining third doesn't care as long as their taxes keep going down.