While the Affordable Care Act was a landmark legislative achievement and granted millions of Americans with access to affordable healthcare for the first time, it is not without its problems. The addition of pre-existing conditions into an industry not equipped to cover them made medical costs not forcastable for insurance companies. The removal of healthy young people from the individual market (included now on their parents' policies) and inclusion of no-lifetime limits bore the same effect, as did the addition of a new group of insurance first timers accustomed to utilizing the emergency room as their primary care doctor. Premiums skyrocketed, especially for those earning too much to qualify for subsidies. In some cases, premiums quadrupled. In states like South Carolina that didn’t expand Medicaid, many were caught in the gap in which they qualified for neither Medicaid assistance nor ACA subsidies. This un-insured group also puts a burden on hospitals, driving up costs for all.
Single-payer has been floated as the answer to the problem, indeed it has been estimated that some 60% of Americans are covered by single-payer now. That said, as of 2016, the United States insurance industry employed 2.6 million people with some 812,000 of those individuals working solely in health insurance with much of the remainder depending at least partially on the health insurance industry for income. The health insurance industry is one of the few industries that allows citizens without a college degree to climb the socioeconomic ladder to the middle class.
As with many complex problems, we must take well-thought out measured steps to restructure health care. First, move pre-existing conditions & no-lifetime limits (those items not forcastable) out of marketplace premiums and have those items be subsidized by the existing funds provided by the Net Investment Income Tax. Removing those items not designed to be insured by the insurance industry, such that they are not randomly tacked on the everyone's premiums should serve to moderate premiums to those we saw in the pre-ACA days. We must also return the individual mandate into the equation.
In December of 2017, our current GOP-controlled Congress passed Tax Reform that will cost America $1.4 TRILLION. In essence, every man, woman, and child in America is being forced to borrow over $4,300 to fund corporate tax cuts. Prior to this reform bill, the corporate tax rate was 35%, but the effective tax rate, due to loopholes, was a reported 18%. Now, the corporate tax rate has been lowered to 21%, and the loopholes have remained. Simple math would suggest Corporations are now paying an effective rate at well under 10%. Corporations received a 40% reduction and small businesses received a 20% reduction while wage earners received nothing more than short-term 'smoke & mirrors'.
It’s true that overtaxing strangles an economy, but it’s also true that demand determines supply. The theory behind December’s Tax Reform is that supply creates demand. The thought that Corporate tax reductions will 'trickle' down to the wage earner who will then stimulate the economy of America has been shown not to be valid.
If Corporate loopholes are closed, Tax Reform can achieve closer to budget neutrality. Cuts to Social Security, Medicare, and Medicaid are being pointed to by the current GOP Congress as a method to offset the outrageous Tax Reform price tag. The deficit will only increase further once much needed Infrastructure rebuilding is stirred into the mix. Tax Reform must be 'reformed' further such that entitlements are not threatened and there is room for Infrastructure improvement.
Student loan debt in our country is 1.48 trillion dollars. Approximately 11% of the 44 million borrowers are in delinquency or default. This debt has rendered many college grads incapable of homeownership and generally supporting a family. Since 1978, tuition costs have increased by 1,120%, more than 4 times general inflation. Similarly, wages have not kept up with inflation, changing college from a luxury to a necessity.
Fixing our education system won’t solve the problem of wage inequality, but it can make a college degree and social mobility more attainable. I believe states should be incentivized to create greater accessibility to affordable higher education. Tennessee now provides qualifying students with free community college and New York provides qualifying students with a free four-year degree. Even two free years of community college can slice the cost of a Bachelor’s degree in half.
Additionally, qualifying high school seniors should be enrolled in the local community college for their final year of high school, reducing the college drop-out rate and raising the number of students who go on to pursue as four-year degree.
For students already in loan repayment, those who consistently make payments on time should qualify for interest rate deduction. Students who have repaid the total of their principal should also be exempt from further interest accrual, only bearing responsibility for repaying any remaining previously accrued interest. Private student loans must also be subject to greater regulation, as the average private student loan can fluctuate excessively, even up to 21% compound interest or greater. We must also expand bankruptcy eligibility to private student loans.
With respect to early life education, we are in dire need of summer school to address summer loss, parent education programs to help them help their students, after school programs to aid working and single parents, public preschool, and comprehensive sex education with parental involvement. Foreign language should be taught in elementary school, during the primary developmental years, instead of being postponed to middle school and later.
Our students deserve more than the minimally adequate education we have provided. If we do not improve the American educational system from bottom to top and make it more accessible, our children will not be well-positioned to fill the new jobs we must create to keep America on the cutting edge of relevance in the global market.