Healthcare: Unintended Consequences

One of the consequences of bashing the Affordable Care Act is a decline in healthcare services for people under the age of 45.

Here’s the story:

  • When adults were required to enroll in a healthcare plan under threat of penalties at tax time, for the most part they did that. The notion was to take the burden off expensive hospital emergency rooms and to have consumers build relationships with physicians who could provide more personalized and knowledgeable care.
  • The government does away with the penalties and most younger adults drop their health coverage.
  • They also drop their relationship with the physician who was providing insured coverage. As of now, 45% of adults between the ages of 18 and 29 don’t have a personal doctor.

There are several consequences:

  1. Doctors with no prior knowledge of a patient may treat the patient inappropriately, including prescribing medications that may not be optimal for the patient.
  2. Doctors with no prior knowledge of a patient may order unnecessary tests, increasing the cost of care.(1)
  3. Major illnesses are more likely to go undetected until they reach an advanced stage requiring more complex and expensive treatment and entailing a higher risk of loss of quality of life or of death.
    • Research published in 2017 showed that the presence or absence of health insurance explained differences in the survival rates for colorectal cancer between blacks and whites.(2) Early detection matters. Having insurance or not appears to impact whether early detection occurs.

We’re hearing horror stories about colon cancer among 20-somethings. There’s a reason. And, of course, this will drive your healthcare costs up when you do need it.


  2. Helmneh M. Sineshaw, Kimmie Ng, W. Dana Flanders, Otis W. Brawley, Ahmedin Jemal. Factors That Contribute to Differences in Survival of Black vs White Patients With Colorectal Cancer. Gastroenterology, 2017; DOI: 10.1053/j.gastro.2017.11.005


  1. Unintended consequences? I don’t think you’re properly evaluating the motivation of the people driving these policy changes. At best, I’d say this falls into the “collateral damage” category for them, and I wouldn’t completely discount the possibility that some see this as a feature, not a bug. The Speaker of the House (for now) is still an Ayn Rand fan, after all.


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