My boss told me something that will always stay with me. I’ve never known him to lie, so I have no reason not to believe him - but nevertheless this is still a personal anecdote.

Anyway, he told me that when he was a teenager, his family had gotten to a point where they moved out of a bad neighborhood and into a rather affluent one thanks to some luck from his parents. He said he went to the store one day and a homeless person was outside the store, asking for help getting back on his feet. My boss, being the asshole teenager he was, told the person to, “just get a job.”

He said the person humbled him immediately, and told him in a very respectful, but firm manner, that he lost his wife and son due a car wreck the year before - that he went bankrupt and eventually homeless paying for their medical bills while they lived, and for their funerals when they died.

My boss tells this story to our new-hires when he can. He typically says that all this person needed was for someone to believe in them and give them another chance, because no one truly helped them when they needed it most.

It isn’t much of a shock to me.

My spouse has just had a two week stay at a local hospital due to a difficult to diagnose issue that started as “pain in leg” and escalated to “can’t walk” in the space of a month. We have regular insurance, and the hospital bill after insurance so far is $4,000 but we know it’s going to probably triple or more by the end of the entire process. The yearly “Maximum out of pocket” on our plan is $14,000 but there are many ways in which the OOP can be exceeded by, say, a doctor being involved who isn’t in network, or a treatment the insurer doesn’t cover.

We are “lucky”, we have ways to cover the inevitable bill. If it had happened ten years ago, when my daughter was still an infant, when our finances were bleeding, my job was barely covering our debt payments, raised in part because of disorganization during the birth, etc, there’s no possible way we could cover the bill that’s coming.

I know people don’t like the ACA being criticized because it’s considered a well meaning attempt to fix the health care system, but here are the problems with it:

1. For most people, it had a net negative effect because of the skin-in-the-game mandate. This is a principle the ACA’s writers signed up to early on to try to get right wingers to support the bill by massively increasing copays and deductibles. Suddenly an ER visit was no longer $100-500, but $1,500 or more. Doctors visits are up from $10 to $50-100. Specialists from $25 now to $75-100. These increases aren’t inflation based, they’re intentional policy. For a software developer like me, I can afford them. For someone working two low income jobs to support their family, a real “hard working American”, it basically makes healthcare unaffordable and unreachable. And all because some swivel eyed ideologue thinks that when you’re lying unconscious bleeding out on the pavement in front of the car that hit you, you’ll save the system money by using your smartphone to call the lowest cost ambulance service in your area.

2. The ACA mandated a “maximum profit” as a percentage of premiums insurance companies are allowed to make, while coupling it with no effort to make insurance companies non-profits (ie not beholden to investors.) The result is that insurers have to intentionally negotiate higher healthcare prices with their providers! No, seriously! Because regular public companies like health insurers have to increase profits every year, and the only way to increase profits if you can’t increase margins or customer base is to increase your supplier costs so you can increase your own prices.

And the cynical part of me says they knew this but didn’t care. The two obsessions were with “pre-existing conditions” and “bankruptcies”, but these are both sides of the same coin. People were facing huge medical bills because their insurers didn’t cover them and bankruptcies were the result. And bankruptcies hurt… banks. And banks seemed to be what they cared about most of all in 2009-2012. They did nothing to stem the foreclosure crisis, for example. Maybe, ultimately, what the ACA was about was protecting banks, creating an environment not where bankruptcies wouldn’t happen, but where those bankruptcies would be about debts in the region of $14,000, not $1M. Something much easier for banks to handle.

That’s the cynical part of me. Part of me hopes that the majority of Democrats who voted for the ACA merely thought it was the best they could do. But those two flaws need to be fixed. Get a Public Option in so there’s at least one non-profit insurer, and abolish the high taxes on “cadillac” plans - the plans that, like pre-ACA plans, had token co-pays and reasonable deductibles.