... It seems to me that there are well-run programs, and there are really badly run programs. Since the ACA is such a political hot issue, I would expect it to come under far more scrutiny than most, which should help to keep things clean for the foreseeable future.
Medicare and Medicaid, for what it's worth, are generally considered to be two of the most efficiently run government programs in existence. They are administered by the Department of Health and Human Services, which is also in charge of ACA.
I haven't followed it closely... But my understanding so far,
just from a little browsing: There has already been so much wrangling involved in getting the law passed, and it has
drawn so much resistance that it has been altered and perhaps, overcomplicated rather much as a result.
I don't think it's dramatizing too much to say, this history even includes the difference between some early proposals -- where single payer was still being seriously considered -- and the final bill, which some say is still largely consistent with big corporate systems that even many Republicans (apart from the vocal "anti-government" wing we see driving the Party so much now?) once were, and still should be, quite happy with.
That being said... I am still betting it's better than the next to nothing we have
had in the past. Which I am still "paying for" after just one, hardly uncommon procedure. Or, it's just possible that I might might never
actually pay for all of it in cash
, but it was a major factor in changing my whole lifestyle and leaving the country. We'll see. Once it's reached that point, the amount of money isn't even so nagging in the long run (it's really nothing compared to people with chronic illnesses) -- as compared to, whether it's really benefitting me (or anyone but certain very bloated companies, really) to go back and pay any
money for the consequences of such a ridiculous system. Look at how many other things I've already changed, soooo
.... Who knows.
I'm not sure about Medicare etc. either actually -- I've heard it does fairly well... Which should not be taken lightly! But I'm not sure what part of that means relatively well e.g. 'for a government program that faces some resistance -- but could be still better if people had never tried to limit it so much' etc., or absolutely well in some more objective measures of actual efficiency.
One can say, oh but there is no
government program that exists without some social pressure and resulting inefficiency... But I think that US politics have made a particularly grand mess with conservatives sniping at these programs in particular as examples of "big government." By which they generally seem to mean -- if you look at what they want
instead? A sizable allocation of tax money and work, blah blah which they would rather hand directly and with less oversight, to big corporate backers!