Marie P. hit the nail in health care right on the head.
I’m not sure how people can miss the big picture here.
Let’s say everyone buys bread. I buy my $1 generic white loaf, people with more money and/or different preferences spend $5 and get an artisanal whole wheat loaf, and you have the range in between. Stores are legally required to provide bread to those who are starving, so they get free bags of scraps, or the government pays for them to get the generic white loaf.
If the federal government then decides to subsidize bread purchases by giving everyone $.50 to $4 a day in bread subsidies, what do we think will happen? The price of bread, obviously, will rise. Now my cheap bread costs $2 a loaf. The very poor buy their bag of scraps for $.50, but the scrap quality goes down because stores can sell the generic bread that comes from at a higher price to me. The very rich now have to pay $7 per loaf, they gripe and get by. Those between now get the same product or worse for more money, while collecting varying subsidies from the government.
And what happens in those areas where the subsidies are not applied? The states that don’t expand Medicaid? Now the folks who bought the $1 bread have to pay $2 for it without getting any government money to make up the difference.
Of course rural hospitals are closing. We took a very poor health care finance system and made it much worse with massive federal subsidies unevenly and irrationally applied. It’s not that complicated. What is harder to understand is how we’re going to get out of this situation. I suspect we won’t, and we’ll just see the increasing fallout of our poor pre-ACA choices (tethering health care payment to employment, allowing the growth of the insurance behemoth and encouraging its interaction in every tiny facet of our health care decision-making) and our poor reform choices (ACA). We already have a nation in extreme anxiety about its health care options, with iatragenisis killing 400,000 Americans a year because we have no free market way to address poor care. You’ll just see more and more of this, the frog in the slowly boiling water became soup a long time ago, we’ll just keep boiling his bones.
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