So from my perspective, the problem here is simple and was foreseen, and the solution is simple, but virtually impossible.
1) United, Humana, and now Aetna are cutting their participation in the exchanges because they can’t turn a profit. Answer: Health insurers should be banned from making profits, as every other developed nation does. Make them public, non-profit, or cooperatives.
2) Aetna is using its large market share to punish/bully the administration for nixing a merger it wanted. This should have the same solution.
3) Insurers are getting too many new (sick) subscribers at once, and/or their existing beneficiaries are getting sicker. But the New York Times recently reported that not only has Obamacare cut the uninsured rate to a modern low (<10%), but it is actually making Americans healthier. At root, those are the fundamental, critical goals of health reform–not profitability or federal deficits and debt. Let’s keep this in mind. So how to solve #3? Health insurance, like voter registration, doesn’t work when people are excluded by default unless they act. Both need to be automatic–in this case so that healthier people who are cheaper to insure are paying into the system. Shared risk is a basic principle of insurance.
But that alone isn’t enough. We still have a crazy patchwork system where people get their health care in different ways from different places. Each comes with a different population, motive, administration, needs…this complication is a big pain for patients and providers, AND it’s a major reason for our very high administrative costs. Our political system isn’t ready to face this reality, but it’s unsustainable and has to end.
WE MUST GET EVERY AMERICAN ON THE SAME HEALTH SYSTEM.
I don’t care as much about which one it is; the imperative is to get everyone on Medicare (like Canada), or everyone on a fully socialized VA/IHS system (like the UK), or everyone on the exchanges or an employer-based system (like Germany). Then you greatly simplify everything, slashing administrative costs, and have one giant risk pool comprised of the whole country. No system is older or sicker or poorer. There are no big year to year changes because change happens slowly in a group of 320 million. And access to and quality of care are equal for everyone. Many of our health care problems will persist until we do this.
One metric people tend to overlook in election results is how many total ballots are cast in each race. Generally you expect more contested or controversial ones to get more votes, but the results in WA are often an instructive insight into what people care about more and less. In 2012, the marijuana and marriage ballot issues got more votes than the races for governor and senator. We had 11 statewide items on the primary ballot last week, and I’ve ranked them here in descending order of total votes cast:
Secretary of State: 1,318,695
Lieutenant Governor: 1,295,050
Insurance Commissioner: 1,294,131
Commissioner of Public Lands: 1,274,766
Attorney General: 1,221,354
Supreme Court 5: 1,162,814
Superintendent of Public Instruction: 1,121,116