One would assume that libertarians and free marketeers would cheer the concept of boycotts, as it is one of the mechanisms that citizens are empowered with in a laissez-faire society.
I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.
If the government is unable to prevent monopolies, then consumers should step in by punishing companies that seek to monopolize.
Edit: Again, that's one of the concepts behind libertarianism, isn't? The idea that instead of relying upon government regulation, there's almost some economic reputation system in place which would cause consumers to reject doing business with bad actors. So in theory, the recourse here would be for the individual consumer to reject Aetna directly in response for their monopolistic practices.
Why not pass such a law? Because that would effectively mean semi-nationalizing a fairly large industry, and if we're going to do that, why not just create an actual single payer and a risk pool the size of the US population and skip the idea of having private firms involved at all.
The biggest problem with the idea of single payer "insurance" is that it's not actually insurance. It bundles in a variety of things such as pre-payment for services, wealth redistribution, price controls for services, and some actual insurance.
A social safety net is a good thing. But if we expect to benefit from the benefits of a competitive system, we have to let firms actually compete.
The core issues have to do with the lack of "insurance" market for things that are actually prepayment (like giving birth, dying of old age after $50K worth of end of life care, etc).
By mandating that consumers buy the "insurance" and mandating that insurers bundle all the non-insurance services into the package, the government essentially controls the market and avoids both the benefits of market competition and accountability for tough decisions such as which care should be covered, etc.
There have been many threats from industry and government. Government can nationalize and can pass laws that reduce profits, and firms can pull back, can merge with each other, and do other things to increase their market power.
The bottom line is that the entire system is ripe for corruption and lack of accountability. Let's face it, for a healthy young person, catastrophic insurance is next to free. Yet all of us are paying fairly high premiums so that old people can be exploited by a healthcare system that happily gives them ineffective surgeries and sells them overpriced and largely ineffective pharmaceuticals.
The system was already corrupt before Obamacare, Obamacare simply cemented many of the most lucrative public/private deals. Both sides intended to scheme a bit after the programs got underway. So we'll see a bit of tit for tat with regulators and perhaps watch one or two of the entrants leave the market allowing the profits to be divided fewer ways.
Nope, I'm not letting this slide by. The Democrats did try to do exactly what you propose in the 90s. If it had worked, we would've had a first-world health care system two decades ago. But it was screamed down by the Republican Congress with the usual taxes-liberty-communism-Stalin rhetoric. The ACA was intended as an improvement over the nightmare we had pre-2010 that was still digestible to Republicans. Remember: it's fundamentally a Republican idea. It's similar to what Gingrich proposed as a counter to Clinton's plan (which is what really boils my blood about conservation opposition to it), and it's more-or-less identical to what Romney implemented when he was governor of Massachusetts.
So yes, the ACA is a "worst of all worlds" compromise, and of course it sucks. Almost all the Democrats I know agree that it should be scrapped and replaced by a single-payer system tomorrow. But since that doesn't seem likely to happen, the ACA is what we've got. And your blaming of the Democrats for the failure of a Republican idea implemented because the Democrat's much better idea isn't politically possible is despicable and disingenuous in the extreme.
He has his gallbladder out and all of a sudden he's a super risky person to insure. How do we get him in a risk pool where his premiums won't be unaffordable?
Incidentally: two members of my immediate family have the same problem he does. No history of serious illness, no current health problems, probably healthier than the median in both cases for their age cohort, but uninsurable outside the exchanges due to bogus pre-existing condition rules.
I am unconvinced that we can. Perhaps though.
2) Are you really convinced that the pre-existing rules you encountered were bogus? Are insurance companies just dumb when it comes to this sort of thing? I tend to assume, absent other evidence, that insurance companies will be profit seeking so would only turn people down if they expected to (probabilistically) lose money on the deal. Perhaps they're just not smart enough to discern differences at this level though? I don't have much experience in this area.
It's interesting to note that McCain proposed this as part of his campaign in 2004 and Obama pilloried him for it.
And it's not just them. Nearly all of the large insurance companies are pulling out of the exchanges because they're losing money. A lot of people believe this is because, as they are currently constructed, the public exchanges are untenable. And that's a very big deal if it's true. Not for the profitability of insurance companies, but for public health care policy in this country.
Basically, gotta get everyone caught up to the healthiest they can be, and afterwards there would be a lot better maintenance, which in return would mean that the companies have a chance of not needing to worry about the adverse selection.
It would probably also help to get rid of the networks and simplify the insurance end at the doctors offices to both reduce costs and get rid of some of the redunancies in addition to having some sort of care and coverage standards that spread across insurances, just so that people are able to get the care they need instead of going with not-quite-so-good-for-them alternatives because they happen to have a crappy prescription plan.
Other changes I would make would be to require all insurers to sell directly to consumers and decouple insurance from employment - much like most folks get their car insurance. In addition, I'd require insurers to use the exchanges if they want to be in the business and make it so that insurers have a national license instead of needing certified in each and every state they sell in. This would not only standardize coverage, but reduce overhead.
Unfortunately, this sort of thing requires planning on a rather large scale and fixing a lot of problems such as affordability of care. The current political climate hasn't been so keen on that sort of long-term planning nor cooporation, not to mention that the companies themselves might not be too keen on that last one either.
2.) I tend to think all pre-existing rules are bogus. Though they say they help with their risk, I'm skeptical. Most the plans I saw wanted folks to have continuous health care coverage to go around some of the rules (I've always gotten insurance through and employer when I lived in the US). Yet having coverage doesn't mean you take care of your condition. The opposite is also true. Obviously, some folks don't take care of x,y, or z because of lack of coverage as well. And things such as gall bladder surgery are more one-time events with few lasting needs after the surgery for most folks.
But I admit that I'm not super well educated on the issue.