Whether the Patient Protection and Affordable Care Act (PPACA) coverage expansion and commercial health insurance provisions are morally justifiable is a big question for free-market purists.
For many other people, a much bigger question is simply whether any of the provisions will really work, and, if so, which ones, how well, and over what kind of timeframe.
A cost control provision might work great in the first few years, for example, and then cut down on doctor, hospital, agent or carrier competition, and backfire in later years.
A vaccination benefits mandate might increase costs in the early years and lead to huge savings in later years, by preventing and postponing illness.
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An effort to limit the value of group health benefits (example: the PPACA Cadillac plan excise tax) might encourage insurers to carve out some services and let consumers pay for those through separate insurance policies or prepaid benefits programs.
But, of course, conventional wisdom might be wrong. A cost control program that wipes out competition might permanently lower costs. The cost of a vaccination mandate program might always outweigh the benefits. A Cadillac plan tax could scare everyone into accepting skimpier benefits packages. You never know. In health finance, experiments are a lot better than theories.
One great thing the PPACA Medicaid expansion and PPACA public exchange subsidy programs could do, even if they eventually fail in every other respect, is simply give analysts better data on what happens when various types of people get various types of insurance.
Does having any kind of coverage help those people get better care? How much does getting care actually improve their health, their years of a healthy life, or their overall lifespan?
What kinds of care improve the newly insured people’s outcomes?
What kinds of care, if any, seem to do the most to control the cost of care?
Managers of all existing and future health care access programs could use the data to improve the programs.