This is an archived article that was published on sltrib.com in 2011, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

For all the sound and fury that has been raised about President Obama's Affordable Care Act, one might be forgiven for thinking that the law has actually changed something meaningful. And, when it fully takes hold in 2014, it still might.

But news from the past few days recalls the reasons why reforms at least as aggressive as those contained in the ACA were, and are, needed.

The cost of health insurance continues to rise, at speeds that far outstrip the rate of inflation, even as the number of medical procedures that some of the insurance companies have been paying for has gone down and the companies' income from other sources, such as the stocks and other investments they hold, has been going up.

As reported in Monday's Tribune, double-digit rate hikes have once again been the norm for Utah's private-sector health insurance providers, both for-profit and non-profit, even as they sit on large reserves and, in the case of four out of five of the state's largest providers, post handsome profits.

There is still a lot of uncertainty over how the new national health care system — with its individual mandates and multi-state exchanges — is going to work. That lets the insurers claim that they must continue to raise rates and stash cash in anticipation of the day when they actually have to sell their product to people who need it, and not cancel their policies the day they actually get sick.

But, with no real oversight regime in place, either at the federal level or by the states, there is no particular reason to accept that the rate hikes are needed or that the companies' cash reserves could not responsibly be tapped to reduce the need for rate hikes. The insurance companies thus take more of our money and provide less service. Deductibles go up, limits go down and recession-wary customers avoid the doctor altogether because they do not feel they can afford the co-pays or the added usage that might lead to even higher premiums later.

It all makes the public option, which Obama proposed but couldn't get through Congress, sound even more attractive than it always did, as a necessary counter-weight to the unchallenged power of the private plans.

In the middle of this national fuss comes Salt Lake County's experiment to contract with OptumHealth — an out-of-state, for-profit insurance company — to take the place of the local, non-profit Valley Mental Health as the main contractor for mental health services for the uninsured.

If we want to be seen as patients, not profits, all of this will need careful watching.