And Let's not forget about the other Deplorables

[KaraBulut]

It has been a failure of the ACA to reduce medical costs but in its defense as long as this country creates new policy by bringing all the industry “stakeholders” and trying to work out a deal in which no one will be harmed reforming the system isn’t even on the table. If both profits and profit margins are sacrosanct you’re just rearranging the deck chairs on the Titanic.

It's not the failure of the ACA, per se. One of the big problems is that a) the Republicans successfully removed the mandates and b) the extension of the parental coverage for children up to age 26 has lowered the pool of "healthy" adults in the market. On the other hand, the people who had chronic medical conditions or pre-existing conditions signed up for ACA plans.

I get a lot of "Can I ask you about something?" questions from 20-somethings who don't have health insurance. I'm happy to help out but I always ask them, "Tell me, why don't you have insurance?". They have no idea that they can pretty much free health insurance due to their low income. Because many of them live in a publicly-funded hospital district where there is an allied medical school, they can also see doctors for a nominal copay. Even when I can prescribe something for them, because they lack insurance they will have to pay the full price for the medication. The low signup percentages for young patients has also been a failure of the ACA since the mandates were removed.

What the ACA cannot address is the ridiculous pricing of pharmaceuticals. One thing that I discovered during the pandemic is how many people are on biologicals that suppress the immune system; those drugs cost thousands of dollars per month. HIV meds, including PrEP, still cost hundreds of dollars per month. The GLP-1 inhibitors are coming down in price but until recently, a month supply of oral GLP-1 inhibitors like Rybelus, and the weekly injectables like Ozempic/Wegovy cost $1,000+ per month. With those kinds of prices, it's no wonder that insurance premiums have skyrocketed.

Another shocker this year: in past years, my COVID-19 vaccine was free since it was government subsidized. Those subsidies expired last year. My COVID-19 vaccine was about $250 this year, which insurance covered at 100%. That is a ridiculous price for a vaccine that was developed from publicly-funded research.