I cringe at re-debating the merits and faults of the ACA all over again, we've had several thoughtful discussions on the forum already but it may be unavoidable since it is a key referendum in the pending election. But I think a discussion on principles, the primitive nature of the argument minus the petty score keeping about "talking points" could be in order. Regarding your specific question about the economic decision it comes down to this for me: We have several social programs in place right now. Social Security was started under the New Deal initiative and has expanded and blown out of proportion and is financially untenable. This year was the first year that it paid out more than it took in. If a private company offered the exact same service to people, it would be charged with fraud. We have welfare, medicare and medicaid that were born of the Great Society, they too have grown way beyond the originally promised scope and scale and, combined with Social Security make up the vast majority of our budget that we cannot pay for with the output of our country. Now we are promised a new program under the same guise. If the Fed could cite one credible example of when they had promised an entitlement, proven that it had the desired results and come in on budget, I would totally be open to the idea even though it conflicts with my constitutional ideals. I've said before, this should be done by the states and I have no problem if any state wants to socialize the the healthcare of their citizens. So to me, as good as your question is, it's moot as I don't believe that the Federal Government can deliver the goods, they have absolutely no track record of doing so. Philosophically, I believe the best means by which to elevate everyone, that all the evidence in the world indicates, is to increase the prosperity of people which is achieved by maximizing freedom and choice not increase the amount of decision making among a relatively small and elite few. In a centralized format, power can expand on demand but knowledge and creativity can not. This was sold under the argument that there were 30M+ people without healthcare. But even the CBO states that even after this, the number of uninsured people will be about 22M. So we upend our system for everyone for 8M people? I can also give you first-hand examples of how unexpected consequences are already happening as a result of this that are hurting people. I guess for me it comes down to the simple decision making principle of "show me the proof" that it falls short for me. I've said it before and I'll say it again, if the UK and Canada can make it work, all the best to you. I'm not remotely convinced that we can based on a lot of history. Meanwhile, I look at what companies like Whole Foods does with medical savings accounts for their workforce and see a great way to address the problem but when the CEO touts the success, he's demonized. This country is not having a rational and open discussion about it. If you mention private solutions, you are immediately charged with a lack of human compassion no matter how many people are actually helped by it. All that creativity and choice will be wiped away and I fear a lot of innocent people will suffer as a result. I think we are seeing a lot of this today. Recently, Atlanta GA voted to raise taxes to improve the mass transit system in that city. It was overwhelmingly defeated and the consensus when voters were asked why they voted against it wasn't that they didn't believe the city couldn't benefit from improved mass transit but that they didn't believe that the government would produce what was promised. I think it is indicative of the tone in the US right now.