The American public will soon be wedged into the Affordable Care Act (ACA), a forklift replacement for the healthcare system that consumers use today.  In this new health care regime, the roles of provider, patient, and payer will be further segregated into winners and losers.  Those postures are a direct result of Congress’ 2010 choice of whom to favor and whom to gouge.

Some health care providers were able to land juicy deals (e.g. the pharmaceutical industry which avoided the negotiated prices for drugs that it endures under Medicaid).  In contrast, the medical device industry was slapped with a 2.3% excise tax (on sales, irrespective of profit or loss).   Managed healthcare firm profits are capped and physicians remain crushed by Medicare and Medicaid paperwork and laughable reimbursement rates.  Clearly some lobbied more effectively than others.

The patient connection to the healthcare system has been reengineered and everyone must participate — you have no choice.  If you don’t buy health insurance, the IRS will fine you and the fine will increase in size each year.

Congress chose to favor the elderly (with continued Medicare) and the sick (with a ban on insurance that excludes pre-existing conditions).  Congress chose to force young and well patients to pay higher premiums than their care costs so that the excess funds could help pay for old and sick patients.  If young and well patients decided to roll the dice and skip insurance, the ACA system will run a higher deficit – so Congress invented a fine for being uninsured.

Congress chose mandatory treatment coverage far more extensive than typical in today’s policies, increasing the cost of coverage.  Some low and middle income families will find health insurance unaffordable so Congress created liberal subsidies for this voter bloc.  And, ever eager to burnish its populist street creds, Congress imposed a new  3.8% “Obamacare” surtax on investment income.  Shortfalls in government funding will come from those who actually pay income taxes, a minority of Americans.

The $2.7 trillion health care system needed renovations that vigorously curb costs – the major impediment to people obtaining the right health services in the right venue.  The ACA does almost nothing in that regard.

Alan Daley is a retired businessman who lives in Florida and who writes for The American Consumer Institute Center for Citizen Research