[quote=EconProf]The bill that was passed had nothing to do with reform. It merely expanded government into the medical sector with a Medicare-style approach. The unnecessarily expensive and doomed Medicare model was used with no thought given to incentives.
Real reform would have allowed insurance companies to compete across state lines, reined in the tort bar, and incentivized both customers and providers to be less wasteful. For example, Health Savings Accounts and minor copays were sidelined.[/quote]

There is no “medicare-style approach” in the ACA, except with regards to specific changes to medicare and broadened the medicare type incentives to providers (which you claim should have been in there and isn’t.) Additionally, contrary to your claim, the medicare model for health insurance and delivery is and always has been an overwhelming success. Its shortcomings are all related to the financing of the program (exacerbated by the, as a practical matter, unfunded Part D, passed under Bush, which was classic spend and kick the bill down the road a generation.).

Reigning in tort laws (if needed at all) would have a minimal effect on overall health care costs. HSA’s, while a good deal for those that participated, have had little effect on controlling health care costs.

Even in states where there is currently theoretical competition, rates have risen dramatically over the last 15 years. There is no evidence that more competition will decrease costs. Medical insurers gouge comsumers. It’s what they do. Though in my opinion poorly conceived, the ACA did set floors on the percentage of premium dollars that must pay for direct health care costs. (Medical Loss Ratio or MLR in insurance lingo.) The inverse of that ratio (or the amount of premium dollars that did NOT go to pay for health care costs, has trippled over the last two decades. Effective the beginning of this year, it is now capped.