To the degree there was popular support for government intervention in the marketplace it had two sources:
1) Liberal concern for the “poor” uninsured.
2) Middle class people with preexisting conditions facing bankruptcy because they could not buy insurance on the pre-Obamacare marketplace.
The truly poor and indigent were receiving medical care at the time. Hospitals could not turn down the poor who were using emergency rooms as primary care facilities. In addition many local government ran free and low cost clinics to serve the poor. However, the press and Democrat politicians made a big deal about the poor being uninsured, equating uninsured status with not receiving medical care. The opponents of Obamacare failed to deal with this deception.
The second issue, pre-existing conditions, was portrayed by those opposing Obamacare as a non issue. People with pre-existing conditions were portrayed by Obamacare opponents (including many on this forum) as greedy people gaming the system by refusing to buy insurance when they were health but then wanting to buy insurance when suddenly confronted with a serious illness or condition requiring expensive and extended medical care.
Unfortunately by ignoring the very real problem of people with pre-existing conditions being bankrupted, the Obamacare opponents gave ammunition to Obamacare proponents. Significant layoffs and unemployment due to the 2008 financial crisis caused much angst in the population. Many jobless workers with pre-existing conditions suddenly found themselves without employer subsidized medical care and were being rejected by insurance companies for coverage in the private market. These people had been insured, and paid into the “system”, for decades, were willing to buy insurance on the private market but couldn’t do to pre-existing conditions, and were facing financial ruin. Opponents of Obamacare were equating these people to someone who drives uninsured, has an accident, and immediately wants to buy auto insurance. The truth is the people had paid into the employer sponsored system for years, were unemployed and kicked off those plans through no fault of their own, and were unable to buy insurance on the private market.
Yes there was COBRA at the time of the layoff, but COBRA eventually ends and private insurers at the time would not write policies for people with critical illnesses coming off Cobra. Obamacare opponents in Congress wouldn’t deal with this real issue. Hence, Obamacare proponents received support because they were advocating for “fairness” and helping ill unemployed middle class people avoid economic ruin.
The healthcare system is now a mess, and neither party is taking any leadership to fix the problem. The Republicans in the House have done nothing during their six years in the majority except conduct over 40 meaningless votes to terminate Obamacare. They’ve not put any alternative policy into legislation. Neither have they passed any reform legislation to bring some needed market reform such as allowing a national market for insurance. Ditto for the Republican majority in the Senate since 2015. Their failure to pass real reform legislation, and have a national debate if the President vetoed the legislation, allowed Obama and the bureaucracy to continue destroying the US healthcare system and oppress the population. By failing to take real action and pass an alternative they have been not only derelict in their duty but have also enabled the disaster we are living with.
The old system had a major flaw in not permitting consumers to purchase insurance across state lines and not permitting insurers to offer the same product nationally. As a result, the very powerful market force of “economies of scale” was not allowed to operate. This issue should have been addressed in Obamacare but wasn’t. The GOP members of Congress have talked about this issue but there has been no legislation coming out of Congress to bring this very powerful free market reform to the system.
Democrats have not pushed legislation to deal with some of the glaring issues with Obamacare because their end game is national health care and they assume the pain being inflicted on the population will ultimately lead to citizens demanding single payer. The GOP, by doing nothing, is collaborating in this effort.
The broken healthcare system is a symptom of our broken political system.
So how, specifically, would you deal with the people who won’t buy insurance until they need it?