i only have a couple of seconds and i hesitate to get into this with limited time, but i'll try to hit a couple of high points.
without exception, the liberals i know who think obama care is a good thing, also think it didn't go far enough. even the president stated a few years ago that single payer was the ultimate goal. to that end, obama care was fairly masterful. it is designed to destroy private insurance and drive as many people into the government controlled exchanges as it can. it almost immediately sets up a two tiered system where those who can afford insurance or to pay cash will still get what they want, and those who can't will get what the government gives them.
there is no cost control in obama care except to set up the unaccountable efficacy panels. this will further limit the choices and care given to those in the exchanges in the name of cost control.
at some point, it will become apparent that this two tiered system is not "fair", and would work far better if everyone were in the exchanges. the government could control all care, tax appropriately, and the selling point will be...once again... cost control. then the exchanges go away because you don't need them anymore and the government controls all.
to pacify those who still want to pay for their own care and get better care, you can do as they have done in england. you force everyone to pay for national health care but allow a few insurance companies to continue. those insurance companies exist to keep those with money from rioting and so they are allowed to reject anyone they chose to reject. for instance, in england you can by private health insurance and stay out of the NHS, but you can't get it if you have a pre-existing condition. as an example: i know of a woman who struggles to pay for private insurance because breast cancer runs in her family. because of the lack of care under NHS, she has watched family members die.
or...they can chose to have no private insurance and we all get what the government gives us.
i go back to what i have seen in england because it is what i am familiar with and because they are the largest in population of the 1st world countries who have gone to a national health care system. the standard of care for almost all diseases is many years behind ours. neurology, diabetic care, etc are 20 to 40 years behind us. hospitals are degrading for lack of money. equipment is not updated and often is not available. if you need a triple bypass because you have come in with a cardiac event, you can wait 6 months...sometimes in hospital, for that care.
i have also worked on the candian border. there we have a flood of patients coming in for tests and care they can't get, or get in a timely fashon. we take care of their high risk pregnancies, neurology patients, joint replacements, etc.
if this plan had been designed to insure people, they could simply insure them at a far lower cost and without the added bureaucracy. it was not.
in addition, it will not control cost. just as throwing money at college students has not lowered college tuition, throwing free care/reduced cost care at people will not lower cost. this also will be used as an excuse for the government to step in.
then there is the other stuff like what people do with free stuff. ever take care of medicare patients? they abuse the system on a regular basis because it's FREE and as long as they don't have to pay for the missed appointments, or the snotty nose vist, what do they care? consider the same attitude extended to an entire population in a generation or two. this, again, is a problem that england faces. they even run public service spots all the time begging people not to go to the doctor for every little thing.....
england has about 65 million people. we have 300+ million people. they have degraded their health care system in a couple of generations and created an institution that they can't afford, but can't get rid of. wonder how long it will take us?
i agree with you that a large part of the problem is with the way we are insured. it is the insurance itself and the idea that we have that someone else should pay for our care that is one of the major problems. there are no market forces in medicine the way it is now.
consider something like laser eye surgery that is not covered by most insurance plans. when it first came out, it was very expensive. as more doctors entered the market and more people wanted it, the cost has come way down. i remember when my BIL had his eyes done and it was over 10,000 dollars and he had to travel to have it done. now, a few years later, i can have it done for 2,000 and have a choice of doctors in my own town to do it. if we had market forces in all common procedures and test, with insurance for catastrophic illness, cost for everything would come down because patients would shop for what they needed, and they'd be informed.
if we had tort reform all those docs who will no longer do charity work, would be willing to consider it again.
there are ways to fix the system....but fixing it was never the plan.