Certainly my focus is not to stoke anyone's political passions but rather to point out that the "mess" and confusion of where the ACA may be right now is a function of the lack of function of the Federal effort to control the health insurance market. It is a market after all and is not very responsive to control. In fact, uncertainty and excessive rules just raise costs and premium paid without providing more care but rather less care per dollar paid.
Imagine building a road without consideration of topography. That is what the ACA did and it started building into a swamp and as the traffic poured onto the new asphalt, it began to crack and buckle. More asphalt was ordered because surely that would make it better and the road continued to sink just like more money only pays premium but does not provide care.
Who is at fault? Everyone.
Why? Because all of us see a little bit of the problem and each of us refuse to "fess up" and fix it.
Why does a pharmacy have so many prices for the same prescription? Why is the price higher for a high deductible insured person versus a cash customer? Why are the prices so hard to compare? Why are prices for care so varied as well? Why are providers still "capitated"? I could ask a million questions, each cause some amount of waste and confusion in our current situation and keep premium costs on the increase.
Let's just get back to basics. Premium should pay for risk and we should pay for care. Simple. I don't know how much my insurance should be but my risk is probably about 100k and so that would equal something closer to my auto insurance per month instead of a fat mortgage. An office visit should be about $40 for the 45 seconds that a doc spends listening to my symptoms and for a PA the same but maybe 2 minutes instead. Simple is always better.