What is Affordable Health Care?

Can the Affordable Care Act succeed? Many current discussions presume that's entirely a function of how well it's administered.  But given the importance of premium subsidies and their linkage to the poverty line, perhaps the biggest challenges to making care "affordable" are larger trends in the economy.  As Marco Ferreira has noted, "One of the main approaches to defining affordability considers other (non-health related) necessary budgetary requirements on families. Necessary budgetary requirements include childcare, food, housing, taxes and transportation."  As those other costs go up, the chance of health care being affordable goes down.

With that in mind, consider the percentage of householders under age 30 with the following problems in 2011:

Unpaid essential needs: 20.2% 
Unpaid rent or mortgage: 10.7% 
Evicted for non-payment: 0.7% 
Unpaid utility bills: 14.5% 
Disconnected utility: 2.8% 
Disconnected phone: 6.3% 
Unmet need for doctor: 9.8%
Unmet need for dentist: 12.5%
Not enough wanted food: 22.8%
Food insecure household: 16.1%

Some foundations may dispute those figures. But the larger picture is clear.  As in many other areas of the economy, the problem lies as much (or more) in improving the job outlook and wages as it does in cutting prices.  You can't squeeze blood from a stone. Nor can you make a vital service like health care "affordable" when oligopolies in finance, communications, and energy squeeze more and more from families with less and less.