If I start a fire insurance company, and I have a policy that you can sign up even if your house is currently on fire, I'm unlikely to stay in business.
Anyone worried about house fires could simply wait and, if they did have a house fire, sign up for my insurance after the fact.
This is why pre-existing conditions are "special" - they are fundamentally incompatible with a free market insurance system. And it is, partially, why American insurance was cheaper previously - insurance companies could simply deny expensive customers and let them die to keep premiums low for the healthier subset of the population they covered.
Republicans were elected to get rid of the "bad part" of ACA - mainly the individual mandate. Saying you want to get rid of that is the exact same thing as saying you want to re-introduce pre-existing conditions, they go hand-in-hand.
Either we deny coverage to those that are already ill, or we force everyone to have insurance (ACA, single payer, public option, whatever).
I don't understand why people are so opposed to the "mandate". We have the same thing in so many other places, only those are handled by paying taxes for things you might not need.
I can't avoid buying "invasion insurance" by not paying for the military. I can't avoid buying "transportation insurance" by not paying for roads. Why is paying for health care any different?
If anything socializing health care costs makes more sense than transportation infrastructure, because the needs are so unpredictable and beyond the individual's control and the costs so potentially huge.
I am opposed to the mandate because it requires me to purchase something from a private party just because I am alive.
If you want everyone to pay something, we (as you pointed out) have something for that, it's called taxes. And that's what pays for your other "insurance" examples. (And don't bring up auto insurance. I don't have to have it, I can choose to not own a car.)
But by involving private companies you have creates perverse incentives that I have no sway or visibility into.
If we want to socialize health care then lets do that, but lets not introduce a private party middle man that not only disconnects the payer from the consumer but has a government mandated client base of the whole US.
I am opposed to it because it is a horrible individual rights breaking precedent.
> Either we deny coverage to those that are already ill, or we force everyone to have insurance
This is the crux of it, but I wish people would stop calling this "insurance". While I agree that all Americans should have some degree of guaranteed healthcare, shoehorning this into the concept of "insurance" is a recipe for failure.
Insurance with pre-existing condition is just health care. You are not insuring against anything.
My guess is that if Republicans want to remove the individual mandate AND the pre-existing condition clause, they're going to have to at least allow for some grace period to allow those currently enrolled in ACA to move to another plan with the pre-existing condition clause still in place.
The problem is that you have a tripple system. You have the insurance for unlikely but expensive accidents/cancer/etc which is what insurance is good for; you have subscriptions for things like annual health screenings, common care etc and finally you have subsidies for those who have shit health.
It would be much better to split the system into those three components: a relatively cheap insurance that you would be unlikely to ever draw on, an optional subscription service that you probably would just pay out of pocket at whatever doctor you trust at whatever price you could get and then something for those who have expensive, preexistent conditions, which is either a government scheme, charity or a required insurance that parents have to take out on their children.
There is no need to require everybody to buy an overprized service bundle.
With regards to pre-existing conditions, Ryan's plan talks about continuous coverage policies. Under a "continuous coverage" policy, a person with a pre-existing condition would need to avoid having any gap in insurance coverage in order to avoid paying more for insurance or being denied outright.
So if you lose your job and your health coverage, insurers would be able to deny you coverage.
But if you never have a gap, then you can't be discriminated against.
Rep. Steve King said " If we guarantee people that we will - that there will be a policy issued to them regardless of them not taking the responsibility to buy insurance before they were sick, that's the equivalent of waiting for your house is on fire and then buying property and casualty insurance.
I think what Steve King said makes sense to me - protections like 'blanket no denial for pre-existing conditions' could incentivize waiting to purchase insurance until a condition arises, which compromises the system.
The gap solution, though, is not a great idea. If someone falls under a certain level of economic or other hard times and incurs a gap for even a very brief duration, it is in my opinion a very harsh penalty to use that as an excuse to deny them coverage. This is especially true when many families pay a large amount for existing coverage.
The only tenable solution is to force everyone to have coverage. If that's the answer, I see no better implementation than single-payer.
Why don't we have two systems? One of guaranteed healthcare for the expensive conditions and one of insurance against everyday issues and accidents. So single payer towards things like cancer and insurance for getting checkups, having a cold, going to the ER, etc. Could some middle ground solution like that work?
A problem there is that some of the most expensive chronic conditions (CVD, Diabetes) can be substantially improved by preventative care.
Hence: The actor paying for chronic care is the one incentivized to provide great preventative care, separating the two will create incentives with negative patient outcomes and cost for chronic illness.
Another less obvious issue is that by splitting healthcare payment between actors, they are weakened against an increasingly monopolistic healthcare provider market. One key reason US healthcare is expensive today is that insurers are weak vs. healthcare providers - splitting them up would further reduce their ability to negotiate better prices.
While there's some truth to the argument that US healthcare is expensive because it pays for much of the worlds medical research, there is plenty of truth to the argument that the rest of the west gets better prices because their single-payer insurance is a massively strong negotiating party fighting for good prices for patients.
It's more like winning a state lottery, where the monthly payout will be terminated if you leave the country for any reason.
There was law requiring insurers to accept you if you switched insurers without a break in coverage; just tweak that law to address common reasons for brief breaks in coverage (say, if you notify & pay either insurer to cover the "gap" within a reasonable amount of time).
This and other problems can be addressed with objective & focused solutions. No need to take over the entire health insurance industry just to fix a few systemic problems. ...and making it illegal to not have coverage isn't acceptable.
I think it's much more complicated then that. Perhaps a different analogy is better:
There are the people who just are bad at organizing their life, and can't really get it together to purchase insurance.
Then there are the (cough) normal middle class people who can either write a check every month or have their employer write the check every month for them.
Then there are the people who prefer paying for things out of their pocket as they go.
The problem is that, as a civilized society, we need to make sure that the people who can't "get it together" are still insured, and the people who prefer paying out of their pocket as they go pay a fair price too.
The ACA in it's current form is probably comparable to a fire department in your analogy.
As others have pointed out the true problems in our system revolve around medical providers price-gouging, someone who is ill and seeking medical attention is not operating within a free market due to the duress of their situation, but we still use free market principles to justify the massive profit margins of the companies that sell to ill people under duress.
I'm not sure if you're being downvoted here, but I think this is the right answer. The major problem in the system and with the ACA is that it continues to try and operate health care in a capitalistic free market. Due to the lack of choice by patients and the fact that they cannot reasonable refuse needed care because of price, the system falls apart.
I believe the only acceptable solution is a single-payer system where the government is able to set pricing limits on services - like medicare/medicaid already work. This is the only way the costs can be reasonable for the consumers of the care.
As a Canadian, I hit CTRL+F and searched for "Canada" in this thread with over 600 comments and didn't find a single result. (Edit: My mistake, missed one other Canadian!) I searched for a few other nations with universal healthcare and couldn't find any references to them, either.
It is really interesting how the American mindset is to never look abroad to see what works and what doesn't. There's something amusingly arrogant about it. Almost as if every other country must be an absolute cesspit that could never have any lessons to offer, although I admit that other countries' universal healthcare systems have been effectively (but unfairly) demonized in U.S. political discourse.
Our system here is far from perfect and comes with it's own unique set of frustrations in terms of timely access to care, but it seems like those frustrations are nothing compared to what millions of Americans put up with.
I have anxiety even travelling to the United States for a couple weeks on occasion when it comes to healthcare. What if something happens to me? Did I buy the right travel insurance? Is there a certain process I need to follow? (Most travel insurance policies I have seen indicate that if you need medical treatment to call them first before you do anything, which seems like an odd thing to do if you're having a heart attack..) Did I fill out the insurance application forms correctly? And if I end up needing care, will the insurance company find some loophole or technicality to deny my coverage?
Many Americans and many politicians often do look to other countries for examples of how to do something right. The problem is we have a loud-mouthed national-pride movement that believes in American exceptionalism and can constantly think of excuses as to why Canada's system wouldn't work here, or the NHS wouldn't work here, or every other country's system wouldn't work here. We're unique, so those other systems won't work here.
We also have a large contingent of people who take immense pride in voting against their own self-interest. They'll look to Canada's system and say "yeah but they wait for days to get an x-ray for a broken arm" ignoring the fact that they themselves couldn't even afford to get an x-ray. But it's worth it because even though I can't get healthcare, the people I hate can't get it either.
As shown by the most recent election, it's political suicide to imply that America isn't the single greatest nation in the world. It's even worse to suggest that we should be asking some other country for help. Those other countries are communists, and the only communist we like is Russia.
Australian here, same opinion. It seems, watching from afar, that the american public is somehow being convinced that free health care is impossible. We have free health care here and there are some issues here and there but in general it works and is not burdensome tax wise. If you want you can pay additional for private insurance and get private coverage in private hospitals, which means a room to yourself and so on, and you can choose your doctor. In the public system you get the doctor available, but when it comes to specialists, they're the same doctors usually, because there's only so many specialists.
Recent experience - my daughter sprained her ankle, so went to the hospital for x-rays. I live outside the city so the doctor we saw was coincidentally our local GP. The price $0, time waited - about half an hour, this was on a Sunday night.
One thing that may be a factor here is the medical practices are run by doctors - no professional manager people which, from what I understand, seem to be in the US health system. The doctors, in general, really are people who want to make people well and thats what they do. Sure they like to make a buck and they do but not at the expense of everyone else.
If you let non medical people into the system to manage it then, I'd look closely at their motives, I suspect you'll find sometimes their motives aren't pure.
In the early 20th century, both Canadians and U.S. citizens formed unions to push for better living/working conditions in their country.
The difference with regard to healthcare is that Canadians convinced their government to provide it, while U.S. citizens convinced their employers.
This was fine for most of the century in the U.S., but towards the end and more recently leading up to the passing of ACA, all but the most zealous unions were broken up and employers were providing healthcare less and less.
Unlike the industrial, early 20th century where conditions were horrible for almost the entire working class, we now have some people who are gainfully employed with healthcare and some who are not. Consolidating these two groups to agree on how to provide healthcare for everyone is difficult, because those who "got theirs" don't see it as a problem until they lose it.
During WWII the government imposed wage controls.. but fringe benefits did not count as wages. And with a shortage in labor because of the war, employers used health insurance and other fringe benefits to attract workers.
Employer provided healthcare is an artifact of ww2 where employee compensation was practically frozen. Employers looked for other ways to create competitive compensation, and turned to healthcare.
Yes. It's absurd that this is even a debated topic when dozens upon dozens of countries around the world have successfully implemented universal health care systems which have resulted in better health outcomes than the US.
> It is really interesting how the American mindset is to never look abroad to see what works and what doesn't.
Oh we definitely look abroad. In fact that's one of the major arguments for a single-payer system in the U.S. - such a system exists successfully in every other capitalist democracy. So why can't we make it work here?
And this looking abroad is not a tonic against bad thinking. Conservatives routinely look at health systems in other countries and decry them: long waiting lists for elective procedures, high marginal income tax rates, etc., etc. Any flaw in another system is magnified and considered a non-starter.
Obamacare was based on an older Republican plan which had been implemented by Mitt Romney in Massachusetts. But in the run-up to Obamacare conservatives hyperventilated about "death panels" and how the ACA was going to destroy the economy. None of which came to pass.
> In fact that's one of the major arguments for a single-payer system in the U.S. - such a system exists successfully in every other capitalist democracy.
Every other OECD country ("capitalist democracy" is a problematic category) except Mexico has some form of universal coverage, but not all are single payer, several are hybrid public/private systems.
One way the US could look to Europe is by not forcing a single one-size-fits-all solution on every state, but rather leave health care to the individual states, which allows for more experimentation, variety, and competition. This would require congress repeal ACA and replace it with no federal health care law, just like is done with Europe's central government.
> There's something amusingly arrogant about it. Almost as if every other country must be an absolute cesspit that could never have any lessons to offer, although I admit that other countries' universal healthcare systems have been effectively (but unfairly) demonized in U.S. political discourse.
Everyone understands the healthcare systems in Canada and most of Europe. There is no point mentioning it because for most of Republicans it's a non-starter. It's incredibly niece of you to think a bunch of liberals have never thought to look elsewhere, at best. At worst you wanted to just blanket insult the US.
The problem is that middle class Americans are charged outlandish rates for the plans.
The plan for my family last year cost over $1200 per month, and this year rose to $1400/month.
Previously, with employer-provided plans I paid at most $400/month for my family.
Not only are the costs outlandish, there are no high deductible plans available for people who are generally healthy. All of the plans, gold, silver and bronze, are geared toward heavy users or highly risk-averse users.
A healthy, disease-free family at an income level to afford $1400/month in health care costs surely ought to be able to purchase a plan that covers catastrophic scenarios and costs a lot less than $1400/month.
In the past I'd had a plan via an employer that was a high-deductible plan. It cost $350/month but I had to pay the first $10K of all costs each year. Do the math, this was a better deal even in the worst case scenario than my ACA plan.
The problem with bundling a progressive tax, a flat fee, a subsidy, and a prepayment plan into one "price" is that it is impossible to tell which dollars apply to what.
I'd much rather have my actual taxes go up a small bit than pay an income-based penalty in my healthcare price.
I'd also much rather self-insure the first $15-20K of risk each year in exchange for a much smaller payment.
One other detail. Nearly all the plans by all the providers are essentially identical. The cheapest bronze plan I could have found was over $900/month! That's for a pretty abysmal level of coverage of most things compared to any other employer provided plan I've ever had.
ACA has got to be the largest tax increase ever foisted on the middle class.
We already have a progressive tax, but let's add an individual mandate, tax credits that phase out at 400% FPL, and cost sharing subsidies which phase out after 250% of FPL.
The maximum value of the tax credits for your family would be nearly the full cost of the premiums at 133% FPL, let's say $12,000. Then on top of that the cost sharing reductions would reduce your out-of-pocket maximum -- which if you're truly unlucky could run your family another $14,300 -- to a maximum of $4,500, so that's worth potentially another $10k.
What this means is ACA is a $12,000 - $22,000 tax on your family depending on your health care utilization, as income rises from 133% - 400% FPL.
For a family of 4 the 133% FPL = $32,250 and 400% = $97,000. So as you make that extra $64,750, in addition to all the other taxes you are paying, you are also phasing in $12,000 - $22,000 of increased payments for the same exact health care. Now that is one hell of a tax.
So while you and your spouse are working your asses off to earn $150k, you can look back and appreciate how $10k went to the town, $10k to the state, $30k to the Fed and ~$15k to the SSA. So it's really just the cherry you're being charged an extra $15k for insurance, come on, you can afford it!
I won't mention all the other subsidies you lose out on for being a productive member of society. Because when you realize the real tax rate approaches 100% on the first $97,000 it's a bit of a buzz kill.
Very true. And all that extra money is helping to fund companies like Mylan when they overprice the epi pen for several years.
Why wouldn't they, customers are insulated from the sticker price but can't really complain because high priced health "insurance" is required.
It's just a coincidence that Mylan took any flak for its abuse of the system. Many other pharmaceuticals are increasing in price way out of proportion to inflation, and way out of step with reality since the R&D costs are all borne before product launch.
"ACA has got to be the largest tax increase ever foisted on the middle class."
That's just Not Even Wrong.
Your health insurance premium is not a "tax". You're getting health insurance. Moreover, not getting a subsidy for your health insurance is also not a tax. You can only use that logic when the tax credit is offsetting another tax. Which it isn't. It's offsetting your health insurance bill.
If, instead, you're trying to claim that every bit of increase in health insurance costs since the ACA is a "tax", that's maybe a bit more defensible, but still Wrong. Health insurance costs have been skyrocketing for decades. The ACA has probably slowed down that trend.
Finally, if you're just complaining that you're healthy but you have to pay for health insurance now...take a walk, please. Eventually, we all get sick. Health insurance only works if healthy people foot the bill of the sick people. That's how insurance works.
It's meaningless to compare employer funded plans to ACA plans without knowing what amount was being subsidized by your company. It's also a different risk pool.
The idea is self-insuring $15-20k is absurd for most people, and most people who buy insurance on the exchanges will have government subsidized coverage.
If you want to argue the government should subsidize more of the cost of this care, I'm all ears. But I don't think we should dismantle the system because it doesn't benefit your precise set of preferences.
> what amount was being subsidized by your company
Around $200 per month. The risk pool aspect would be true if the risk were the dominant factor in the price, which I think it isn't.
> The idea is self-insuring $15-20k is absurd for most people
People who can afford $1400/month even if no healthcare is used? I'd much rather save the money and if someone in my household has a catastrophic scenario put it on a credit card or spend the next <12 months on a payment plan of $1000/month.
> subsidize more of the cost of this care
The key word in that sentence is this. What care are we talking about? The ACA plans cost a minimum of $900/month even if I use no care at all (and that's for the plan with very high co-pays, etc.).
I've been on an ACA plan for the past two benefit years, and the plans keep getting much more expensive and offering worse coverage. The question is, why is this happening? And why is it that on the so-called "marketplace" there is not a high deductible plan that had been available via non-ACA plans via employers?
I think the answer is that it is far from an actual marketplace. There must be some incentive for providers not to offer high deductible plans or actual risk-based plans.
A risk pool is a way of packaging a lot of people into one financial model, but the larger and more heterogeneous the group, the more the prices should reflect actuarial reality. The exact opposite is the case.
Considering that so much money and research has gone into building the healthcare.gov website, why can't I simply adjust sliders to optimize the plan the same way I book a flight? I'd like to slide the monthly premium slider to the bottom, slide the maximum out-of-pocket to about 15x the mid-high premium price, adjust the "worst case event" slider to about $20K and (hopefully) find a plan for a few hundred dollars a month, which I know exists in the actual market because I had it a few years ago! If anything, a larger risk pool should have allowed insurers to offer plans that strongly discourage adverse selection (such as high deductible plans) and reflect the actual risk of cost incurred to the insurer.
The plans on healthcare.gov not only fail to offer this, but the wording, the pricing examples, and fine print is all out of some sort of bureaucratic nightmare scenario. I actually had a physician and a lawyer sit with me to try to understand the fine print and the likely cost of a few scenarios other than pregnancy and diabetes (which are shown), and we sat there confused for several hours.
I'd like to see our president sit before the nation sharing his desktop screen and watch him navigate through the site and explain the answers to the very simple things we were wondering about, as well as explain some of the more confusing terminology, as well as things like "why are there two separate plans that are so similar being offered by this company?" or "which of the priced items on this list are excluded from the individual deductible?" I'm quite sure that he'd need to do quite a bit of research and rehearsal before he'd be able to give such a demo with confidence.
When we put trust in our officials to handle things for us, there is a tremendous amount of responsibility that they take on in that capacity. Here we were, one highly computer-literate person, one doc, and one lawyer, utterly flummoxed for several hours. Imagine the average person after a long day trying to make this very important choice for his/her family. It's just wrong.
Maybe the idea is to make all the plans more and more similar until there is really just one choice that is priced based on income and nobody feels it's worth the time searching or reading any of the coverage descriptions because we all realize that the plans are all nearly the same by design, and that we're just meant to pay our "share" based on income and be grateful that such great care has been provided for us.
One thing is for certain. It's not a marketplace. There are simply not competitive plans. There is no way to sort the plans according to any differentiating factors. The "wizard" that the site offers tries to partition people into three groups based on expected usage, but does not offer any consideration to low users or users who are comfortable with the idea of getting a large bill and either taking on debt to pay it off or going on a payment plan with the provider.
And, far worse, all any of the plans I reviewed do to create an incentive for low use is subsidize non-emergent primary care visits. There is zero incentive beyond that to reduce one's use of care. Since the spread between the cheapest and most expensive plan is so small, anyone who expects to need any healthcare at all is better off choosing a silver or gold plan. If this incentive is different for people whose coverage is subsidized, I'd consider it discriminatory fwiw.
> Not only are the costs outlandish, there are no high deductible plans available for people who are generally healthy. All of the plans, gold, silver and bronze, are geared toward heavy users or highly risk-averse users.
Isn't this just because now insurance companies have to cover preexisting conditions and also not charge them exorbitant prices? Naturally, they would be taking a loss in order to do this so that burden is instead shifted onto the healthy people. To prevent healthy people from just not buying insurance, the mandate was made because it's economically unfeasible without them.
If you're the type of person who would normally use a high deductible plan, you're worse off, but that's the way it was supposed to be. Presumably if one day you get very sick though, you will still be able to get insurance.
We shifted the burden of healthcare from lower class and sick to middle class.
But the fundamental problem is high cost of healthcare. Capitalism is usually a ruthlessly effective tool, but it doesn't seem to work with healthcare due to lack of choice.
Maybe it doesn't make sense to invest so much money into health?
Is it a worthy trade-off getting 80% of our current healthcare quality for say 50% of the cost?
It's a tough call to make, but this country is in decline and we need to make tough choices.
I'm a 19-year old developer working my ass off last 4 years for silly startups. Currently I make $30/hour but paying around 30% of my income in taxes.
Baby boomers benefited from generation before them and borrowed money from gen x'ers/millenials and they run this country into ground.
Once my agegroup starts seriously voting I feel like we won't have a lot of pity for older age groups and their retirement plans.
I support raising minimum wage to livable standards, but I hope universal income comes soon.
Over the last year I've been getting burned out working 60 hour weeks trying to use latest languages and libraries, while my company is hiring $3/hour phillipino php/WordPress codemonkeys...While all I wish in life is to Haskell in peace for next 30 years and then die.
I'm still trying to work toeard American dream, but it's dead for all but the software industry.
It's disilousining to see rich stealing the fruits of my labour while I have to pay government to keep the lower class alive.
As kids we were told about wonders of globalization, democracy, and America.
In the real world we now have to deal with fucked up environment, economics and Putin flexing his geopolitical dick.
So you older folks got us into this mess, what the hell do we do now?
I quit my job and moved to Colorado ("Health First Colorado" === medicaid). Over the winter holiday I broke my collarbone.
If it weren't for medicaid, I would be flat broke. my bills start at $5k... that's only the first bill I've seen. My savings would be dissolved, and I would be forced to find work for somebody else.
Instead, because of this coverage, and in spite of limitations on the amount of time I can work at a computer with a busted arm, I am able to continue my entrepreneurial efforts. My partners and I are all hopeful that this will be a very valuable use of our time, and our investor's money. I hope to be able to pay Colorado & the USGov back in spades, through taxes.
* - edited to correct Colorado Cares --> "Health First Colorado"... because I didn't know what I was talking about.
edit 2 - HFC is medicaid for those who qualify... Thanks HN for educating me :P
Which states have universal Medicaid? I'm surprised this hasn't become a bigger thing.
Having insurance tied to employment is utterly terrifying. You'll stick it out in a sub-standard job to maintain coverage. You'll be fearful of taking risks on self-employment. It's the exact opposite thing you'd do if you wanted to encourage entrepreneurship.
Sry... I'm new to CO. Your'e right... Amendment 69 failed (72% against or something?!?! who knows... I voted in favor).
The correct name is "Health First Colorado". I signed up the day I was hurt, they backdated the signup to the month prior. It took less than 15 minutes to become covered.
I've been working for 20+ years, with spats of insured or not-insured throughout... mostly uninsured. After I left my SF gig, I gave up my insurance & didn't get any more since I'd already had 6 months for the year.
I have a pre-existing condition that prevented me from getting non-employer sponsored insurance. When the exchanges came online in my state I decided to leave my job and get an ACA plan for my family, while trying to bootstrap my company. That lasted all of a single year because of 30% premium hikes and 290% deductible hikes made ramen bootstrapping no longer possible.
I'm still working in startup space because of connections I made, but I'm now tied to employment and could never again be a founder, unless one of my current bets pays off.
Yay for elimination of pre-existing condition restrictions. But what good is insurance if you can't afford it?
Do you know a large reason why premiums and deductibles hiked ?
What I read, and I did read this online and haven't had the time to look for primary sources so please take with a grain of salt, but worth looking into is this:
pre-existing condition check was a major risk to the insurance industry since nobody knew how much it was going to cost them. So the ACA told insurance companies we'll subsidize some of your costs until things settle down (this is different than subsidizing people's payments). However when it came time for the gov to pay, Republicans blocked most of the subsidy payments to health insurance companies (I think they only received 12% of the expected amount).
And then because insurance companies didn't get that subsidy they obviously passed the cost onto consumers. And I'm sure whatever subsidy was further promised by the Gov they could no longer rely on so they priced that risk in as well.
Moreover, health care costs have been rising for everyone in the same way over the same time period. I was paying for a small group plan (for my startup) for the last few years, and the per-employee cost was within a few dollars of identical to the equivalent-coverage ACA plans in California. Crazy, right?
The GP comment is just another example of how there's a ton of uninformed anger on this issue. People are spitting mad because they're realizing that health care is becoming really expensive, and they think the ACA is to blame because they heard about the ACA last. The amount of actual understanding approaches zero, because few people pay for their own healthcare in the USA.
I kind of want the GOP to just burn everything down and expose everyone to the full pain of this absurd system (in true, "free market" fashion). We'll have a political revolution overnight.
an important sidenote to this: the taxes for the subsidy payments didn't disappear. The republicans could have used money earmarked for this exact purpose and instead decided that the government should keep the money. They chose that health care costs should rise and taxes should stay up.
And despite all of that, health care cost growth still dropped
The flip side of this, is that you couldn't have done this:
"I decided to leave my job and get an ACA plan for my family, while trying to bootstrap my company."
Before the ACA, because you couldn't have gotten any health care coverage at all. Thus after the ACA, you had an opportunity that would not have been possible (safely) previously.
The ACA tamped down the second derivative of the premium increases, but not the first derivative. Your premiums would have been much higher if it weren't for the ACA, and it will likely continue to rise after the repeal.
How? The ACA mandated cost-plus structuring for the medical insurance industry, which provides all the incentives for rampant healthcare cost (and by extension, premium) inflation.
Married, two kids. Everybody reasonably healthy, have a decent job.
Healthcare costs have become expensive as shit because of the ACA. That's not a partisan talking-point: that's the bottom line in our household budget.
The happy-face anecdotes the ACA's advocates trot out are lovely, but there are far more people in my position.
Medicaid eligibility cutoff is based on the federal poverty level, which for a family of 4 is $33,465/yr. That's only slightly more than rent in a distant suburb of the bay area.
It's frustrating to see so much energy wasted in fragmenting health coverage solutions in the US. This makes it so costly, that it _looks_ like it's too expensive or inefficient, making right wing politicians justify the fact that it should be everyone for themselves.
As a Canadian with full health coverage, without any special requirements except renewing a picture card every 5 years, this looks like a very dangerous situations for millions of poor people. And while the system isn't perfect, and we do have some wait list on special cases, most heavy or light illness get treated quickly.
Even for the richer US citizens, it seems like a waste of time and a big overhead + legal battles looming on possible contract conflicts.
In term of equality of chances for that "American dream", this looks like the biggest imbalance one can imagine, just beside education.
The prevalence of employer-offered, private health insurance is – like many facets of American life and institutions – an interesting path dependency of WW2.
The federal government imposed limitations on the ability of private firms to offer higher wages, so that the government could more easily recruit workers for war industry. Private employers found a loophole. Offering health insurance.
Something just seems wrong about a lot of these stories citing the provision that they're allowed to remain on their parents insurance until they're 26. Because the story is really, "not having to worry about the high cost of health insurance afforded me the luxury of taking more financial and career risks." Surely we can do better for people who are older than 26 or who don't have the option of getting insurance through their parents. If we wanted to give everyone this kind of benefit we would just have universal healthcare with the state acting as everyone's 'parent'.
The counterpoint is course you're able to take more risks when you have fewer life-dependent expenses, so we should just pay for everyone's utilities, food, and housing too. You might even throw expenses for dependents in there too for older folks. What's special about healthcare except that it's expensive?
Deaths due to lack of medical care (2009)[3]: 45,000
What's different is the magnitude. Although the United State's patchwork of services for the homeless is ostensibly supposed to give everyone access to food and shelter, people do fall through the cracks. But it is not an endemic problem like lack of health care.
[1] Debatable, and I can't find a solid source. The only malnutrition related deaths I can find are in elderly populations and abused children.
I could decide to live in a tiny apartment, turn off the heater and eat ramen. With a chronic condition, there's no way I could have made healthcare a similarly manageable expense (other than maintain a full-time job and limit my entrepreneurship to nights/weekends).
> What's special about healthcare except that it's expensive?
Great question. Everyone needs food, everyone needs shelter, everyone needs medical care, but this deep passion only exists for the last item.
My opinion is because the system we have today is basically a wealth transfer from the taxpayers to large interest groups (nurses' unions, big pharma, etc).
> Everyone needs food, everyone needs shelter, everyone needs medical care, but this deep passion only exists for the last item.
Programs exist to make food and shelter universally available, as well, and while imperfect, the proportion of the population unable to afford food or shelter is lower than the pre (or even post) ACA rate of people being unable to afford healthcare.
The fact that the problem is less solved for healthcare is probably why there is more visible passion on the issue.
Yeah, I think it's hilarious that most of these were "I am and/or was under 26 so I can freeload off my parents' employer-provided plan! Thanks Obama!"
The healthcare system is totally a disaster, and it really should be fixed, but giving college-aged kids a free pass for a few more years isn't really a solution.
Readit News
Anyone worried about house fires could simply wait and, if they did have a house fire, sign up for my insurance after the fact.
This is why pre-existing conditions are "special" - they are fundamentally incompatible with a free market insurance system. And it is, partially, why American insurance was cheaper previously - insurance companies could simply deny expensive customers and let them die to keep premiums low for the healthier subset of the population they covered.
Republicans were elected to get rid of the "bad part" of ACA - mainly the individual mandate. Saying you want to get rid of that is the exact same thing as saying you want to re-introduce pre-existing conditions, they go hand-in-hand.
Either we deny coverage to those that are already ill, or we force everyone to have insurance (ACA, single payer, public option, whatever).
I can't avoid buying "invasion insurance" by not paying for the military. I can't avoid buying "transportation insurance" by not paying for roads. Why is paying for health care any different?
If anything socializing health care costs makes more sense than transportation infrastructure, because the needs are so unpredictable and beyond the individual's control and the costs so potentially huge.
If you want everyone to pay something, we (as you pointed out) have something for that, it's called taxes. And that's what pays for your other "insurance" examples. (And don't bring up auto insurance. I don't have to have it, I can choose to not own a car.)
But by involving private companies you have creates perverse incentives that I have no sway or visibility into.
If we want to socialize health care then lets do that, but lets not introduce a private party middle man that not only disconnects the payer from the consumer but has a government mandated client base of the whole US.
I am opposed to it because it is a horrible individual rights breaking precedent.
This is the crux of it, but I wish people would stop calling this "insurance". While I agree that all Americans should have some degree of guaranteed healthcare, shoehorning this into the concept of "insurance" is a recipe for failure.
Insurance with pre-existing condition is just health care. You are not insuring against anything.
My guess is that if Republicans want to remove the individual mandate AND the pre-existing condition clause, they're going to have to at least allow for some grace period to allow those currently enrolled in ACA to move to another plan with the pre-existing condition clause still in place.
It would be much better to split the system into those three components: a relatively cheap insurance that you would be unlikely to ever draw on, an optional subscription service that you probably would just pay out of pocket at whatever doctor you trust at whatever price you could get and then something for those who have expensive, preexistent conditions, which is either a government scheme, charity or a required insurance that parents have to take out on their children.
There is no need to require everybody to buy an overprized service bundle.
So if you lose your job and your health coverage, insurers would be able to deny you coverage.
But if you never have a gap, then you can't be discriminated against.
Rep. Steve King said " If we guarantee people that we will - that there will be a policy issued to them regardless of them not taking the responsibility to buy insurance before they were sick, that's the equivalent of waiting for your house is on fire and then buying property and casualty insurance.
The gap solution, though, is not a great idea. If someone falls under a certain level of economic or other hard times and incurs a gap for even a very brief duration, it is in my opinion a very harsh penalty to use that as an excuse to deny them coverage. This is especially true when many families pay a large amount for existing coverage.
The only tenable solution is to force everyone to have coverage. If that's the answer, I see no better implementation than single-payer.
Hence: The actor paying for chronic care is the one incentivized to provide great preventative care, separating the two will create incentives with negative patient outcomes and cost for chronic illness.
Another less obvious issue is that by splitting healthcare payment between actors, they are weakened against an increasingly monopolistic healthcare provider market. One key reason US healthcare is expensive today is that insurers are weak vs. healthcare providers - splitting them up would further reduce their ability to negotiate better prices.
While there's some truth to the argument that US healthcare is expensive because it pays for much of the worlds medical research, there is plenty of truth to the argument that the rest of the west gets better prices because their single-payer insurance is a massively strong negotiating party fighting for good prices for patients.
There was law requiring insurers to accept you if you switched insurers without a break in coverage; just tweak that law to address common reasons for brief breaks in coverage (say, if you notify & pay either insurer to cover the "gap" within a reasonable amount of time).
This and other problems can be addressed with objective & focused solutions. No need to take over the entire health insurance industry just to fix a few systemic problems. ...and making it illegal to not have coverage isn't acceptable.
How can you possibly think that?
There are the people who just are bad at organizing their life, and can't really get it together to purchase insurance.
Then there are the (cough) normal middle class people who can either write a check every month or have their employer write the check every month for them.
Then there are the people who prefer paying for things out of their pocket as they go.
The problem is that, as a civilized society, we need to make sure that the people who can't "get it together" are still insured, and the people who prefer paying out of their pocket as they go pay a fair price too.
As others have pointed out the true problems in our system revolve around medical providers price-gouging, someone who is ill and seeking medical attention is not operating within a free market due to the duress of their situation, but we still use free market principles to justify the massive profit margins of the companies that sell to ill people under duress.
I believe the only acceptable solution is a single-payer system where the government is able to set pricing limits on services - like medicare/medicaid already work. This is the only way the costs can be reasonable for the consumers of the care.
It is really interesting how the American mindset is to never look abroad to see what works and what doesn't. There's something amusingly arrogant about it. Almost as if every other country must be an absolute cesspit that could never have any lessons to offer, although I admit that other countries' universal healthcare systems have been effectively (but unfairly) demonized in U.S. political discourse.
Our system here is far from perfect and comes with it's own unique set of frustrations in terms of timely access to care, but it seems like those frustrations are nothing compared to what millions of Americans put up with.
I have anxiety even travelling to the United States for a couple weeks on occasion when it comes to healthcare. What if something happens to me? Did I buy the right travel insurance? Is there a certain process I need to follow? (Most travel insurance policies I have seen indicate that if you need medical treatment to call them first before you do anything, which seems like an odd thing to do if you're having a heart attack..) Did I fill out the insurance application forms correctly? And if I end up needing care, will the insurance company find some loophole or technicality to deny my coverage?
We also have a large contingent of people who take immense pride in voting against their own self-interest. They'll look to Canada's system and say "yeah but they wait for days to get an x-ray for a broken arm" ignoring the fact that they themselves couldn't even afford to get an x-ray. But it's worth it because even though I can't get healthcare, the people I hate can't get it either.
As shown by the most recent election, it's political suicide to imply that America isn't the single greatest nation in the world. It's even worse to suggest that we should be asking some other country for help. Those other countries are communists, and the only communist we like is Russia.
Recent experience - my daughter sprained her ankle, so went to the hospital for x-rays. I live outside the city so the doctor we saw was coincidentally our local GP. The price $0, time waited - about half an hour, this was on a Sunday night.
One thing that may be a factor here is the medical practices are run by doctors - no professional manager people which, from what I understand, seem to be in the US health system. The doctors, in general, really are people who want to make people well and thats what they do. Sure they like to make a buck and they do but not at the expense of everyone else.
If you let non medical people into the system to manage it then, I'd look closely at their motives, I suspect you'll find sometimes their motives aren't pure.
The difference with regard to healthcare is that Canadians convinced their government to provide it, while U.S. citizens convinced their employers.
This was fine for most of the century in the U.S., but towards the end and more recently leading up to the passing of ACA, all but the most zealous unions were broken up and employers were providing healthcare less and less.
Unlike the industrial, early 20th century where conditions were horrible for almost the entire working class, we now have some people who are gainfully employed with healthcare and some who are not. Consolidating these two groups to agree on how to provide healthcare for everyone is difficult, because those who "got theirs" don't see it as a problem until they lose it.
During WWII the government imposed wage controls.. but fringe benefits did not count as wages. And with a shortage in labor because of the war, employers used health insurance and other fringe benefits to attract workers.
The unions jumped onboard later.
https://en.wikipedia.org/wiki/Health_insurance_in_the_United...
Employer provided healthcare is an artifact of ww2 where employee compensation was practically frozen. Employers looked for other ways to create competitive compensation, and turned to healthcare.
http://www.npr.org/templates/story/story.php?storyId=1140451...
Oh we definitely look abroad. In fact that's one of the major arguments for a single-payer system in the U.S. - such a system exists successfully in every other capitalist democracy. So why can't we make it work here?
And this looking abroad is not a tonic against bad thinking. Conservatives routinely look at health systems in other countries and decry them: long waiting lists for elective procedures, high marginal income tax rates, etc., etc. Any flaw in another system is magnified and considered a non-starter.
Obamacare was based on an older Republican plan which had been implemented by Mitt Romney in Massachusetts. But in the run-up to Obamacare conservatives hyperventilated about "death panels" and how the ACA was going to destroy the economy. None of which came to pass.
Every other OECD country ("capitalist democracy" is a problematic category) except Mexico has some form of universal coverage, but not all are single payer, several are hybrid public/private systems.
https://mises.org/blog/how-us-states-compare-foreign-countri...
Everyone understands the healthcare systems in Canada and most of Europe. There is no point mentioning it because for most of Republicans it's a non-starter. It's incredibly niece of you to think a bunch of liberals have never thought to look elsewhere, at best. At worst you wanted to just blanket insult the US.
The plan for my family last year cost over $1200 per month, and this year rose to $1400/month.
Previously, with employer-provided plans I paid at most $400/month for my family.
Not only are the costs outlandish, there are no high deductible plans available for people who are generally healthy. All of the plans, gold, silver and bronze, are geared toward heavy users or highly risk-averse users.
A healthy, disease-free family at an income level to afford $1400/month in health care costs surely ought to be able to purchase a plan that covers catastrophic scenarios and costs a lot less than $1400/month.
In the past I'd had a plan via an employer that was a high-deductible plan. It cost $350/month but I had to pay the first $10K of all costs each year. Do the math, this was a better deal even in the worst case scenario than my ACA plan.
The problem with bundling a progressive tax, a flat fee, a subsidy, and a prepayment plan into one "price" is that it is impossible to tell which dollars apply to what.
I'd much rather have my actual taxes go up a small bit than pay an income-based penalty in my healthcare price.
I'd also much rather self-insure the first $15-20K of risk each year in exchange for a much smaller payment.
One other detail. Nearly all the plans by all the providers are essentially identical. The cheapest bronze plan I could have found was over $900/month! That's for a pretty abysmal level of coverage of most things compared to any other employer provided plan I've ever had.
We already have a progressive tax, but let's add an individual mandate, tax credits that phase out at 400% FPL, and cost sharing subsidies which phase out after 250% of FPL.
The maximum value of the tax credits for your family would be nearly the full cost of the premiums at 133% FPL, let's say $12,000. Then on top of that the cost sharing reductions would reduce your out-of-pocket maximum -- which if you're truly unlucky could run your family another $14,300 -- to a maximum of $4,500, so that's worth potentially another $10k.
What this means is ACA is a $12,000 - $22,000 tax on your family depending on your health care utilization, as income rises from 133% - 400% FPL.
For a family of 4 the 133% FPL = $32,250 and 400% = $97,000. So as you make that extra $64,750, in addition to all the other taxes you are paying, you are also phasing in $12,000 - $22,000 of increased payments for the same exact health care. Now that is one hell of a tax.
So while you and your spouse are working your asses off to earn $150k, you can look back and appreciate how $10k went to the town, $10k to the state, $30k to the Fed and ~$15k to the SSA. So it's really just the cherry you're being charged an extra $15k for insurance, come on, you can afford it!
I won't mention all the other subsidies you lose out on for being a productive member of society. Because when you realize the real tax rate approaches 100% on the first $97,000 it's a bit of a buzz kill.
Why wouldn't they, customers are insulated from the sticker price but can't really complain because high priced health "insurance" is required.
It's just a coincidence that Mylan took any flak for its abuse of the system. Many other pharmaceuticals are increasing in price way out of proportion to inflation, and way out of step with reality since the R&D costs are all borne before product launch.
That's just Not Even Wrong.
Your health insurance premium is not a "tax". You're getting health insurance. Moreover, not getting a subsidy for your health insurance is also not a tax. You can only use that logic when the tax credit is offsetting another tax. Which it isn't. It's offsetting your health insurance bill.
If, instead, you're trying to claim that every bit of increase in health insurance costs since the ACA is a "tax", that's maybe a bit more defensible, but still Wrong. Health insurance costs have been skyrocketing for decades. The ACA has probably slowed down that trend.
Finally, if you're just complaining that you're healthy but you have to pay for health insurance now...take a walk, please. Eventually, we all get sick. Health insurance only works if healthy people foot the bill of the sick people. That's how insurance works.
The idea is self-insuring $15-20k is absurd for most people, and most people who buy insurance on the exchanges will have government subsidized coverage.
If you want to argue the government should subsidize more of the cost of this care, I'm all ears. But I don't think we should dismantle the system because it doesn't benefit your precise set of preferences.
Around $200 per month. The risk pool aspect would be true if the risk were the dominant factor in the price, which I think it isn't.
> The idea is self-insuring $15-20k is absurd for most people
People who can afford $1400/month even if no healthcare is used? I'd much rather save the money and if someone in my household has a catastrophic scenario put it on a credit card or spend the next <12 months on a payment plan of $1000/month.
> subsidize more of the cost of this care
The key word in that sentence is this. What care are we talking about? The ACA plans cost a minimum of $900/month even if I use no care at all (and that's for the plan with very high co-pays, etc.).
I've been on an ACA plan for the past two benefit years, and the plans keep getting much more expensive and offering worse coverage. The question is, why is this happening? And why is it that on the so-called "marketplace" there is not a high deductible plan that had been available via non-ACA plans via employers?
I think the answer is that it is far from an actual marketplace. There must be some incentive for providers not to offer high deductible plans or actual risk-based plans.
A risk pool is a way of packaging a lot of people into one financial model, but the larger and more heterogeneous the group, the more the prices should reflect actuarial reality. The exact opposite is the case.
Considering that so much money and research has gone into building the healthcare.gov website, why can't I simply adjust sliders to optimize the plan the same way I book a flight? I'd like to slide the monthly premium slider to the bottom, slide the maximum out-of-pocket to about 15x the mid-high premium price, adjust the "worst case event" slider to about $20K and (hopefully) find a plan for a few hundred dollars a month, which I know exists in the actual market because I had it a few years ago! If anything, a larger risk pool should have allowed insurers to offer plans that strongly discourage adverse selection (such as high deductible plans) and reflect the actual risk of cost incurred to the insurer.
The plans on healthcare.gov not only fail to offer this, but the wording, the pricing examples, and fine print is all out of some sort of bureaucratic nightmare scenario. I actually had a physician and a lawyer sit with me to try to understand the fine print and the likely cost of a few scenarios other than pregnancy and diabetes (which are shown), and we sat there confused for several hours.
I'd like to see our president sit before the nation sharing his desktop screen and watch him navigate through the site and explain the answers to the very simple things we were wondering about, as well as explain some of the more confusing terminology, as well as things like "why are there two separate plans that are so similar being offered by this company?" or "which of the priced items on this list are excluded from the individual deductible?" I'm quite sure that he'd need to do quite a bit of research and rehearsal before he'd be able to give such a demo with confidence.
When we put trust in our officials to handle things for us, there is a tremendous amount of responsibility that they take on in that capacity. Here we were, one highly computer-literate person, one doc, and one lawyer, utterly flummoxed for several hours. Imagine the average person after a long day trying to make this very important choice for his/her family. It's just wrong.
Maybe the idea is to make all the plans more and more similar until there is really just one choice that is priced based on income and nobody feels it's worth the time searching or reading any of the coverage descriptions because we all realize that the plans are all nearly the same by design, and that we're just meant to pay our "share" based on income and be grateful that such great care has been provided for us.
One thing is for certain. It's not a marketplace. There are simply not competitive plans. There is no way to sort the plans according to any differentiating factors. The "wizard" that the site offers tries to partition people into three groups based on expected usage, but does not offer any consideration to low users or users who are comfortable with the idea of getting a large bill and either taking on debt to pay it off or going on a payment plan with the provider.
And, far worse, all any of the plans I reviewed do to create an incentive for low use is subsidize non-emergent primary care visits. There is zero incentive beyond that to reduce one's use of care. Since the spread between the cheapest and most expensive plan is so small, anyone who expects to need any healthcare at all is better off choosing a silver or gold plan. If this incentive is different for people whose coverage is subsidized, I'd consider it discriminatory fwiw.
Isn't this just because now insurance companies have to cover preexisting conditions and also not charge them exorbitant prices? Naturally, they would be taking a loss in order to do this so that burden is instead shifted onto the healthy people. To prevent healthy people from just not buying insurance, the mandate was made because it's economically unfeasible without them.
If you're the type of person who would normally use a high deductible plan, you're worse off, but that's the way it was supposed to be. Presumably if one day you get very sick though, you will still be able to get insurance.
We shifted the burden of healthcare from lower class and sick to middle class.
But the fundamental problem is high cost of healthcare. Capitalism is usually a ruthlessly effective tool, but it doesn't seem to work with healthcare due to lack of choice.
Maybe it doesn't make sense to invest so much money into health?
Is it a worthy trade-off getting 80% of our current healthcare quality for say 50% of the cost?
It's a tough call to make, but this country is in decline and we need to make tough choices.
I'm a 19-year old developer working my ass off last 4 years for silly startups. Currently I make $30/hour but paying around 30% of my income in taxes.
Baby boomers benefited from generation before them and borrowed money from gen x'ers/millenials and they run this country into ground.
Once my agegroup starts seriously voting I feel like we won't have a lot of pity for older age groups and their retirement plans.
I support raising minimum wage to livable standards, but I hope universal income comes soon.
Over the last year I've been getting burned out working 60 hour weeks trying to use latest languages and libraries, while my company is hiring $3/hour phillipino php/WordPress codemonkeys...While all I wish in life is to Haskell in peace for next 30 years and then die.
I'm still trying to work toeard American dream, but it's dead for all but the software industry.
It's disilousining to see rich stealing the fruits of my labour while I have to pay government to keep the lower class alive.
As kids we were told about wonders of globalization, democracy, and America.
In the real world we now have to deal with fucked up environment, economics and Putin flexing his geopolitical dick.
So you older folks got us into this mess, what the hell do we do now?
Would that still be true if you had to pay retail for all your care?
If it weren't for medicaid, I would be flat broke. my bills start at $5k... that's only the first bill I've seen. My savings would be dissolved, and I would be forced to find work for somebody else.
Instead, because of this coverage, and in spite of limitations on the amount of time I can work at a computer with a busted arm, I am able to continue my entrepreneurial efforts. My partners and I are all hopeful that this will be a very valuable use of our time, and our investor's money. I hope to be able to pay Colorado & the USGov back in spades, through taxes.
* - edited to correct Colorado Cares --> "Health First Colorado"... because I didn't know what I was talking about.
edit 2 - HFC is medicaid for those who qualify... Thanks HN for educating me :P
Having insurance tied to employment is utterly terrifying. You'll stick it out in a sub-standard job to maintain coverage. You'll be fearful of taking risks on self-employment. It's the exact opposite thing you'd do if you wanted to encourage entrepreneurship.
http://www.denverpost.com/2016/11/08/coloradocare-amendment-...
The correct name is "Health First Colorado". I signed up the day I was hurt, they backdated the signup to the month prior. It took less than 15 minutes to become covered.
I've been working for 20+ years, with spats of insured or not-insured throughout... mostly uninsured. After I left my SF gig, I gave up my insurance & didn't get any more since I'd already had 6 months for the year.
By the end of December, I needed it.
Edit - link: https://www.colorado.gov/hcpf/colorado-medicaid
I have a pre-existing condition that prevented me from getting non-employer sponsored insurance. When the exchanges came online in my state I decided to leave my job and get an ACA plan for my family, while trying to bootstrap my company. That lasted all of a single year because of 30% premium hikes and 290% deductible hikes made ramen bootstrapping no longer possible.
I'm still working in startup space because of connections I made, but I'm now tied to employment and could never again be a founder, unless one of my current bets pays off.
Yay for elimination of pre-existing condition restrictions. But what good is insurance if you can't afford it?
What I read, and I did read this online and haven't had the time to look for primary sources so please take with a grain of salt, but worth looking into is this:
pre-existing condition check was a major risk to the insurance industry since nobody knew how much it was going to cost them. So the ACA told insurance companies we'll subsidize some of your costs until things settle down (this is different than subsidizing people's payments). However when it came time for the gov to pay, Republicans blocked most of the subsidy payments to health insurance companies (I think they only received 12% of the expected amount).
And then because insurance companies didn't get that subsidy they obviously passed the cost onto consumers. And I'm sure whatever subsidy was further promised by the Gov they could no longer rely on so they priced that risk in as well.
The GP comment is just another example of how there's a ton of uninformed anger on this issue. People are spitting mad because they're realizing that health care is becoming really expensive, and they think the ACA is to blame because they heard about the ACA last. The amount of actual understanding approaches zero, because few people pay for their own healthcare in the USA.
I kind of want the GOP to just burn everything down and expose everyone to the full pain of this absurd system (in true, "free market" fashion). We'll have a political revolution overnight.
And despite all of that, health care cost growth still dropped
"I decided to leave my job and get an ACA plan for my family, while trying to bootstrap my company."
Before the ACA, because you couldn't have gotten any health care coverage at all. Thus after the ACA, you had an opportunity that would not have been possible (safely) previously.
Married, two kids. Everybody reasonably healthy, have a decent job.
Healthcare costs have become expensive as shit because of the ACA. That's not a partisan talking-point: that's the bottom line in our household budget.
The happy-face anecdotes the ACA's advocates trot out are lovely, but there are far more people in my position.
As a Canadian with full health coverage, without any special requirements except renewing a picture card every 5 years, this looks like a very dangerous situations for millions of poor people. And while the system isn't perfect, and we do have some wait list on special cases, most heavy or light illness get treated quickly.
Even for the richer US citizens, it seems like a waste of time and a big overhead + legal battles looming on possible contract conflicts.
In term of equality of chances for that "American dream", this looks like the biggest imbalance one can imagine, just beside education.
The federal government imposed limitations on the ability of private firms to offer higher wages, so that the government could more easily recruit workers for war industry. Private employers found a loophole. Offering health insurance.
Still, we all know what it's like to have a major design flaw in the legacy codebase.
The counterpoint is course you're able to take more risks when you have fewer life-dependent expenses, so we should just pay for everyone's utilities, food, and housing too. You might even throw expenses for dependents in there too for older folks. What's special about healthcare except that it's expensive?
Deaths due to homelessness (2010)[2]: 700
Deaths due to lack of medical care (2009)[3]: 45,000
What's different is the magnitude. Although the United State's patchwork of services for the homeless is ostensibly supposed to give everyone access to food and shelter, people do fall through the cracks. But it is not an endemic problem like lack of health care.
[1] Debatable, and I can't find a solid source. The only malnutrition related deaths I can find are in elderly populations and abused children.
[2] http://www.nationalhomeless.org/publications/winter_weather/...
[3] http://news.harvard.edu/gazette/story/2009/09/new-study-find... this is a higher end estimate from 2009, the lowest estimate I could find was 18,000 from a study done in 2002
(I'm the first story in the article)
Great question. Everyone needs food, everyone needs shelter, everyone needs medical care, but this deep passion only exists for the last item.
My opinion is because the system we have today is basically a wealth transfer from the taxpayers to large interest groups (nurses' unions, big pharma, etc).
Programs exist to make food and shelter universally available, as well, and while imperfect, the proportion of the population unable to afford food or shelter is lower than the pre (or even post) ACA rate of people being unable to afford healthcare.
The fact that the problem is less solved for healthcare is probably why there is more visible passion on the issue.
The healthcare system is totally a disaster, and it really should be fixed, but giving college-aged kids a free pass for a few more years isn't really a solution.