Well, its looking as if it will be 2012 or 2016 at the very least before Americans have a political candidate or progressive party on a national level who makes universal healthcare that also makes healthcare affordable for those who really need it a priority enough to actually make it happen.
To his credit Obama has committed to make US healthcare more efficient by 2019, by embracing the troubled Massachusetts model which dodges the question of affordability and leaves many sick either "insured" but still unable to afford actual care or needed drugs, or uninsured and facing either a fine, or needing an exemption from the law because they could not find a plan- and still uninsured.
That's a problem.
Here is another real world example of another major problem with the risk pricing model. It scares people away from preventative and diagnostic care. What about the person who may be healthy on paper now, say they have insurance now, but who is presented with a symptom which may be of a new condition? One that would increase an insurance company's exposure to risk. (Making them not a desirable customer. Insurance companies would prefer not to cover them or perhaps cover them, take their money, but later dump them if they make claims.)
So, (this being the United States, home of the barbaric healthcare system) should they test for it, with the knowledge that some test results may make them "uninsurable", if they lose their job with its group plan that spreads the risk around, OR should they "wait and pray" for real "change" and hope that they do not die before it comes? (Meanwhile, avoiding contact with the medical system.)
The reason I ask is that I have a friend who lives in another state. He has symptoms that he thinks could be cancer.
He is a blue collar employee, almost 40, and could easily end up out of work for a year or so if his company folds.
If he gets diagnosed with something serious, whenever, he can't have a period of noninsurance, because he may never be able to purchase nongroup insurance. If he lived in MA. he would be one of those who could not afford a policy within his income, so he would be exempt or perhaps less likely, fined for not having insurance.
He wants purchasing affordable insurance on the private market to be an option for his family as he has three children and a wife who currently get their insurance through his threatened job. (His wife works in a coffee shop and does not get insurance.)
Obama's risk pricing model would price insurance "fairly for both insurer and insuree", based on cost times some calculated risk plus profit, I would guess, but for a formerly middle class person with a medical condition, that fair price could be so far out of reach that it might as well be millions of dollars a year. Many people are just getting by. (The devil is in the details.)
(Moving to Canada, Europe or Australia isn't an option for them. They are Americans, and this is their home.)
What should he do? Wait and pray? Or test and pray?
Another consideration. Drugs to treat cancer can cost as much as $1000 a month or more, but his current insurance policy has a $1000 YEARLY cap on prescription costs.
Obama seems to like the Massachusetts model. It elimiantes the "free riders" who were being subsidized by the providers as writeoffs. Its also hurt many free clinics in urban areas. Money that used to go to them is now going to the insurance companies and drug companies, who charge more in MA. now. (more demand)
Massachusetts's basic minimal healthcare policies for the healthy, as well as for the ill, often don't include prescription drugs at all. They seem perhaps designed to insure the government more than the people.
The consumer driven healthcare model ("choice") saves money by making the patient pay more out of pocket through exemptions and cost shifting.
Earth to Obama, we have a problem here. People can't afford this path you have placed us on.