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The Study Health Care Reform Desperately Needs

Now that millions of people have used coverage bought on the Affordable Care Act exchanges for a year, it is time for a comprehensive study that questions the entire basis of the law.

In concept, the design of the study I want would be fairly simple: Step 1) Get a representative sample of users willing to share the health care information for the past year. Step 2) Look at each individual’s actual out-of-pocket spending over the last year to see if, and by how much, they would have been better off had they selected a different plan on the exchange. Obviously, you are going to want to adjust this data to take into account things like individuals’ probability of a major illness/accident.

Sadly, I lack the resources or ability to conduct this study, but I strongly encourage the federal government, state government, non-profits, and Universities to pursue it.

The results from such a study should be fundamental to determining how we move forward. The entire health care law was based on the premise that regular people can do an effective job of shopping around for extremely complex insurance products on their own. There is strong evidence, though, that isn’t true.

Numerous surveys have shown many people lack basic understand of health insurance terms and struggle to do the math necessary to make use of that information. Perhaps most damaging is one experiment in which people where asked to choose between eight possible insurance plans, and only 21 percent of participants selected the financially best option. On the actual health care exchanges, the number of options is often much larger. It is possible that we are wasting billions of dollars of individual and government money on exchanges, and that they are basically no more effective at helping people select the best insurance policy than a dartboard would be.

Of course, all this data only offers reasonable suspicion that the structure of the law is inherently flawed. That is why we need studies involving real people’s interactions with the actual program to find out the truth about it.

If, contrary to my informed predictions, the results of such a study find a majority of people on did a very good job selecting the best policy for them, I will strongly reconsider my positions.

On the other hand, if such a study shows most people did a poor job of shopping for insurance on the exchanges, the public should demand a mea culpa from President Obama, his administration, and the Democratic party leadership. Most importantly, it would mean we should dramatically change the program. At the very least, it should entail a radical restructuring how the exchanges work. It would be even better to replace it with a system of directly providing people with basic public insurance.


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Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at