Ignoring the uninteresting politics of it, the ACA essentially just extended the existing health insurance system to people who don’t have employers by forcefully creating pools of people where before the sickest would be excluded by insurers entirely. The only way that can be offered by for-profit entities (or even not-for profits that don’t have government tax revenue to fund them) is by jacking up prices for young/healthy people to cover all the old/sick people now being allowed into the game. That’s what happened.
That has positive/negative arguments to it, but what the ACA didn’t do is anything meaningful to get costs under control. The ACA started from a false premise–that health insurance companies are why we spend like 2x as much per capita on health care than I believe any other OECD country (going off the top of my head there.) Healthcare companies are rent-seeking inefficiencies but the whole concept of them actually was promulgated by the entities most responsible for the mess we’re in–health care providers, the U.S. medical guild and hospitals broadly. Health insurance companies was their creature, defeat of UHC over 60 years ago was their political wrangling. What’s odd is some of these organizations are even not-for profit hospitals and such, with relatively modest CEO pay (modest meaning like $400k-500k, but that is relatively modest all things considered.) I suspect for some of them it’s just that capturing more money gets them nice and nicer buildings, fancier equipment, more prestige etc. Greed seeps in even without a direct shareholder–profit motive relationship.
Despite the incorrect statement above “single payer UHC” is not a global standard or a first world standard. The broad standard is universal coverage, control of provider pricing, and strong protections on ruinous out of pocket costs. Some countries this means a multi-payer system where the poor pay nothing and even the middle class pay paltry sums, with enforced controls on pricing. Some countries this means the government does all the payment so has full control of price by being the only purchaser. Some it even means all doctors are employees of the government instead of government paying independent practitioners.
A proper ACA could have just clipped their nuts. Pass a law saying all medical providers in the country have to charge off the Medicare table, whatever Medicare pays for something, that’s what the doctor has to charge for anything. If you don’t like it, no medical license. That wouldn’t fix all the problems but you’d see serious changes in pricing right away, and a short-term doctor shortage. Ultimately you’d need government to step in to fund doctor training, because people won’t go a quarter million in debt without inflated salaries at the end of the road.
Healthcare providers operate much like a guy who privately owns a dam that overlooks your town, and who has the legal authority to open it and flood the town anytime he wants. What price would he charge to not open the damn? The answer is, whatever he wanted. Entities with power like that have to be controlled by government, just like monopoly public utilities. For some things like emergency service hospitals have true monopolies genuinely based on geography and such. For others like cancer treatment, it’s more like a cartel. Since everyone agrees to limit the supply of new guild members (look at how many different specialists people visit now versus 1970, but how we’ve hardly increased our throughput for training new doctors since then, oh and also look at how many more people live in the United States in 2014 versus 1970) all of them are going to have high prices, so being able to shop around from one cancer treatment provider to another is just a myth. Just like in a true cartel, you may be able to go to different members of the cartel to buy, but you’re not really exercising genuine consumer power because of how the cartel operates.
Health insurance companies are miserable to deal with and people hate them. So they were the target of the ACA, but of course even it was in many ways a windfall to them. People don’t tend to want to think of their doctors negatively, but they are the ones really to blame.