I think what ataturk was saying is that it's not enough to say that we need "reform". Reform can absolutely have a negative impact. My own health insurance rat

I think what ataturk was saying is that it's not enough to say that we need "reform". Reform can absolutely have a negative impact. My own health insurance rates have gone up quite a bit, as have my deductibles and copays. My raw healthcare costs have also gone up, and it's gotten much more difficult to figure out how much things are going to cost before agreeing to pay for them. Summer before last I was living in Charlottesville, VA and working a job that did not include benefits. My wife and I are in our early 30s and have two young children; none of us have any significant long-term medical issues. The most basic "bronze" plan available that exempted us from the ACA fine was $1,400 / month. I did the math and saw that the break-even point for me where insurance would actually save me money was somewhere around $35k / year in healthcare costs. Since then, more insurers have pulled out of Virginia and marketplace rates there are the highest in the country. What we had prior to the ACA was objectively less efficient than most of the developed world. What we had from 2014-2017 was much worse than it was before, though, for anyone except perhaps those whose coverage was highly subsidized. It's yet to be seen what will happen now with the repeal of the individual mandate, but I expect things will get worse yet. It's a positive financial thing for me and my family if we have to go back out the marketplace to be able to buy plans that don't meet the government minimums, but from a system perspective it'll just increase the mean level of risk for those that are actively insured and drive up premiums. I think the way forward for my family if we're not under and employer plan is to save the money that would have in the past been used to pay insurance premiums, and to purchase catastrophic coverage that doesn't kick in until those savings are depleted. I would welcome an expansion of tax-advantage healthcare savings accounts - particularly if it were possible to manage that money in a longer-term investment like a 401k plan. After all, the plan is not to need to spend a ton of money on healthcare when we're young.