Somewhere between the utopian idea that health care can, and should be, free and the idea that it should be “every man for himself,” there is a middle-ground that is humane but not economically ruinous.
Perhaps the greatest benefit this nation might gain from the Affordable Care Act is that, with its failure, Congress has the actual public support - and the political cover implied- to finally address real reform. That must include tort reform, interstate competition, FDA rules, etc. It won’t be simple and push-back will come from the special interests.
A first critical step should be the education of the public between what is, or is not, insurance. The structure of insurance is that it is basically a gamble. We hedge our bet that we will need medical care against the insurer’s bet that we will remain relatively healthy – both sides have skin in the game.
When one or the other has no financial risk (free care for the individual or government guaranteed profitability for the “insurer”) that structure collapses.
To that end, insurance companies shouldn’t be publicly supported, and individuals who can afford insurance but choose not to carry it should bear the financial consequences. A safety net for those temporarily unemployed, the handicapped, or those below the poverty level should be the easy part of the fix.
Congress now has the impetus and several good plans to choose from. Now let’s see if they have the courage to fend off those who will actively try to maintain the status quo.