L7 scoops the NYTimes!
So New York Times is not yet quoting Lobby Seven Commentary. But, maybe they should, because we scooped them, writing a "Grading Obamacare" story four full days before they did. You can read their story yourself, but its conclusions are broadly consistent with mine. I will comment on a couple items I found interesting.
Their thesis is that the ACA had the effect of changing nation's "baseline expectations for how health care should work." This is an important point which I did not discuss. Before the ACA, the idea that Americans had a right to health care was not yet universal. There was a large uninsured population and always had been. They had a right to emergency room care if they broke their leg in a car accident, but as a society we accepted (or tried to ignore) the fact that ~15% of the population did not have access to systematic, ongoing care (e.g. cancer treatment). Listening to the complaints about Obamacare (limited networks, high deductibles etc) indicates to me that the vast majority of the population now considers this unacceptable. This will have an effect on the politics of the debate going forward.
One point that I didn't address is that health insurance is still tricky to shop for. I don't see any theoretical reason why it needs to be; the choices in health insurance aren't so much broader than in care insurance. But having recently shopped for myself in the non-group market, I can tell you that buying health insurance is still really tricky.
It's interesting to note is that they also punted on the ACA's effect on total healthcare spending. This is such a tough question, I'm not sure we will ever be really able to answer it. But it's probably safe to say that we are not yet on a clear trajectory to matching the rest of the world in terms of getting value per dollar spent.