First, people will increase their use of health care because they'll be able to afford it, and that means illnesses can be caught earlier and treated more effectively in many cases. That can save money throughout the whole system, ultimately, but it will drive up healthcare spending. And the flip side of the coin is that people will also increase their spending on care that isn't necessarily effective. The Affordable Care Act has some measures on the provider side to try to hold down unnecessary and wasteful treatment, but it really only has the teeth for doing that in Medicare.
Emergency room use will probably actually increase, because people will have insurance to cover their visits, and will probably continue to use the ER for things that aren't necessarily emergencies. That's because universal health insurance doesn't mean that there aren't barriers to getting care—lack of local primary care providers, inability to get time off work to see the doctor, all of the things that makes life a struggle for many people will continue to exist, insurance or no. That ties inextricably into the next point McIntyre makes: "Social determinants of health, defined by the CDC as 'the circumstances in which people are born, grow up, live, work, and age,' also play a huge—albeit less clearly understood—role in health." Nutrition, a safe and healthy environment, education—all these things factor into health. The U.S. spends just $0.56 on social programs for every dollar spent on healthcare, and inverted ratio from every other developed nation's spending.
Of course there's good news. Getting more and earlier health care helps avert catastrophic illnesses, and will save many from catastrophic healthcare costs. Perhaps as a result of not having to worry about having their lives ruined by a lack of health insurance, people who have it report better mental and physical health. That was found both in a survey by Rice University and in a study in Oregon of newly enrolled Medicaid patients.
Ultimately, health insurance saves lives—for the people who have it and who have access to good care. The ACA gives the country a good start but it's not the silver bullet for a very broken system.
Insurance can't solve a problem that's incredibly fundamental to our health spending problems: spending is distributed across different patients in a radically unequal fashion. About 5 percent of patients are responsible for half of all health spending. Meanwhile, the cheapest 50 percent of patients account for less than 3 percent of spending. […] Expanding coverage isn't likely to change this distribution. Other health reforms—changing how we pay for care, not just who we cover—hold much more promise.Obamacare is how you start reform, and it might even have the elements of an ultimate healthcare system reform. For example, the Swiss system maintains private insurance—it just effectively regulates both insurers and healthcare providers and device makers and pharmaceuticals to keep costs down. Getting single payer actually might end up being easier than forcing the industry to cut its profits or a government how to effectively regulate, but the possibility still remains. The ACA puts the country on that path.
But first we have to get beyond the "incoherent mishmash" that is the current Republican party.