10 ms·

I am a Republican. More in fact, Fiscal Constitutional conservative. Now that thats out of the way. I hate the ACA. Its overreach by what the government sho

I am a Republican. More in fact, Fiscal Constitutional conservative. Now that thats out of the way. I hate the ACA. Its overreach by what the government should be doing. No where in the constitution does it say the government is allowed to force law abiding citizens to do something. ACA does exactly that. It forces people to do things against their will. Or they will be forced to pay a fine. Alright, don't down vote me just yet. Lets repeal the ACA. But I certainly see things that should be quickly made into law. * Preexisting conditions cannot be denied and should be slightly elevated costs compared to the average user. * Age 26 under the parents health care plan, fine, but damnit kid, get a job. Do something with yourself. * Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. * Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. * Lastly, I want hospital prices published. I want to shop around. * I am business friendly, but these are common sense laws. I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. Complete overreach and strictly unconstitutional.

beatpanda 10y ago
How did you just read a long list of young entrepreneurs who were enabled and encouraged to start businesses because of having their healthcare covered, and you're still writing dumb shit like "GET A JOB!!"?
- spoiledtechie 10y ago
  Because they are in fact living off the backs of their parents. They are in fact living off the money that was funded to them by people who earned that money. Either ask for more money, or work your way through it. Its not too hard.
  - FalcorTheDog 10y ago
    I know right? I can't believe poor people don't just ask for more money. Then they wouldn't have to be poor! It's so simple!
mschuster91 10y ago
> I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. The problem with this POV is that young, healthy people end up having no insurance and thus leave the older, unhealthier population to pay all the bills, whereas a full-insured population would distribute the financial load. Also, it would lead to young, healthy people foregoing insurance in order to save money, and then when catastrophes happen (you're talking about living on the land, so imagine something as harmless as scratching yourself on rusty farm equipment, being bitten by an animal... both can send you to the hospital for weeks!), these people would face financial ruin. The purpose of mandatory healthcare thus is to protect elderly or otherwise pre-conditioned people from having to pay devastatingly high premiums, and to protect people literally from their own short-sightedness.
- spoiledtechie 10y ago
  Ever heard of an HSA?
  - mschuster91 10y ago
    By what I read (admittedly, on Wikipedia, I'm not US-based), a HSA is voluntary and so subject to the same problem that young, healthy people will skip payments. Also, if there's only 50k in the account and the bill is 100k, you're still straight screwed.
JonFish85 10y ago
>> * Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. I think this is something that a lot of small-government conservatives don't want--it's moving responsibilities from the state governments to the federal government.
- spoiledtechie 10y ago
  There is no responsibility of healthcare by the states or federal if you remove this. Just medicare and medicaid.
  - matthewmcg 10y ago
    Incorrect--both insurers and providers are regulated primarily at the state level. Allowing insurers to sell across state lines would be a federal action overriding state sovereignty which is typically not thought of as a "conservative" position.
    - mullen 10y ago
      I also can't imagine that would be constitutional either.
    - spoiledtechie 10y ago
      Right. So stop the state regulation. Mission accomplished and welcome to my way of thinking!
wrsh07 10y ago
1) The government forces law abiding citizens to pay taxes, get vaccines, educate their children, etc... 2) Sam Altman agrees with you that it's okay to repeal it as long as we maintain the best parts of it. > "If Congress ends up repealing it, I hope they earnestly try to preserve the best parts, and put in place something better." We have to start somewhere. The provision about preexisting conditions, and by extension the ACA, is literally life-saving.
- spoiledtechie 10y ago
  Death and Taxes. Not Death, healthcare, vaccines, education. The government doesn't require me to get vaccines. Nor does it require me to educate my children.
  - AnimalMuppet 10y ago
    I agree with you on vaccines. I'm not sure, legally, that you are correct about education (look into truancy laws). Now, you can homeschool if you choose, or place your children in a private school. But I'm not sure, legally, that you can leave them completely uneducated.
    - wrsh07 10y ago
      State laws require certain vaccines [with exemptions] before you attend school: https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.ht... Private schools can also require vaccines. These are good things. We want people to be vaccinated and literate. We want everyone to be able to receive medical care. In the US, that means we want everyone to be insured.
  - dragonwriter 10y ago
    > Death and Taxes. Not Death, healthcare, vaccines, education. Well, correct as far as healthcare goes, even with the ACA "mandate". You can choose not to get insurance, and you get some extra taxes in return.
yincrash 10y ago
Do you think it's okay to wait for a replacement after repeal, or come up with changes / replacement before repealing?
rm_-rf_slash 10y ago
In general you make good points, but I am curious about a few potential gaps: 1: If people choose not to get health insurance and then have to go to the ER, who pays for that? You and me. In most cases, it is cheaper for people to get preventative care and reduce their chances of a very expensive ER visit. 2: Preexisting conditions. Sure, but without a guaranteed customer base supported by subsidies then those people will be effectively denied insurance by having to pay insane premiums and deductibles. I have seen no evidence thus far that effectively counters this argument. Lastly, you say you want to live off the land in some small town somewhere and you don't want the government to force you to pay for other people. Splendid! Say hello to Thomas Jefferson for me. But who builds the roads that lead to your house? What about utilities, water, internet? If you slip and fall down the stairs and break your leg who do you call, 911? If so, who pays for the 911 service, let alone the ambulance to take you to the hospital? Again, I do agree with your premise, but since in my experience most libertarian arguments tend to crack under the pressure of public goods (like national security), where do you draw the line between independence and the needs of the populace as a whole?
- spoiledtechie 10y ago
  1. Like ALL companies, which a hospital is, They can write it off, but ALSO they allocate that already into their budget..... All companies have expected losses. What gives the right of the govt to take charge of hospitals and say otherwise. All companies have expected losses and they allocate those into their budget. 2. Then prices will increase within each insurance company and as a user, I will pay for the insurance I want, rather than be forced. 3. Oh Stop. I didn't say I wouldn't pay taxes. When did Healthcare become a government problem, rather than something that can be done through businesses. Its a business! If you can't afford to pay the bills then work a little harder to do something better with your life.
stinkytaco 10y ago
Your solutions rely on something that does not exist in health care: information parity. A true free market requires information parity. Health care is complicated, thus information parity does not exist. Regulation is the answer to dealing with that lack of information parity. A hospital cannot "publish prices" because prices vary wildly based on many factors. Even if they did, how am I supposed to know what I need for my healthcare? If I go to the doctor and they say "you need a surgery and it will cost 10,000" the posted prices do not tell me if I need that surgery at all, just what they cost. And, of course, the most expensive medical care is emergency, a time when price shopping is not possible. > Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. I'm not opposed to this, but it does remove state control over insurance regulation, which is an anathama to Republicans. I also have no idea how it will drive down costs? Are some states that much healthier than others? > Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. I don't even know where to start. If I can opt out of paying for some medically approved procedures, where does it end? Can I say that I want to opt out of ob/gyn care for unmarried women?
- bzbarsky 10y ago
  > A hospital cannot "publish prices" because prices vary wildly based on many factors. Here's a question: Dentists routinely publish prices. If you ask them how much some procedure will cost, they will tell you. If there is uncertainty, they will give you a range (e.g. to account for the possibility that complications will arise during an oral surgery). What is different in the hospital situation, apart from some rather extreme measures taken to obfuscate pricing? > And, of course, the most expensive medical care is emergency Is it? Or is it end-of-life? Genuinely curious to see numbers here! > I also have no idea how it will drive down costs Prices, not costs. The current situation is that in a lot of states there are somewhere on the order of 1-3 companies offering insurance of certain types at all. For example, for Maryland, I believe there is only one company offering an ACA-compatible PPO (everyone else has HMOs or even EPOs). See https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 for where I got that data. Of course in a monopoly situation there is absolutely no incentive for a monopolist to cut prices. Why would they? So to the extent that prices represent excessive profits (as opposed to the actual costs of health care), allowing cross-state insurance sales should drive them down. People who believe insurance companies are price-gouging should be _very_ in favor of removing restrictions on such sales.
tasty_freeze 10y ago
> We should be able to opt out paying for it, especially if it goes against my religion and frankly it does Does this exception generalize? From the start, I felt it was immoral to go into Iraq, topple the government, get 4000+ US soldiers killed and cause the deaths of hundreds of thousands of Iraqis. The pennies you pay for birth control a nothing compared to what I as compelled to pay for a war I didn't support from the get go. Can I get my money back for that one? I'm sure my objection to it is/was as sincere and deeply felt as your objection to birth control.
- spoiledtechie 10y ago
  Its not about my pennies. Its about my faith.
  - noobermin 10y ago
    I don't know if you realized it, but you are close to saying "government should tighten its belt unless it's stuff I believe in". Then, both sides can make the argument, and there is never any deficit reduction, we keep spending on things we want.
  - serge2k 10y ago
    It's about trying to impose your faith on others. Do you not realize how awful that is? How much of a hypocrite it makes you to hide behind freedom of religion as a means to try to force your religious beliefs on others? Especially via their health care. How would you feel about tying health in to praying to Mecca multiple times a day? How about if you work on the sabbath you lose your coverage? Divorced? No health care for you sinner. STD coverage should probably be banned. I mean sure, there are other ways to get AIDS but if you were having sex in a nice normal marriage then you probably wouldn't get it.
    - spoiledtechie 10y ago
      Imposing my faith on others. Disagree. They impose birth control on me.
nantes 10y ago
Apologies in advance for cherry-picking points to respond to, but ... > * Age 26 under the parents health care plan, fine, but damnit kid, get a job. Do something with yourself. I don't think you can simply equate having a job to "do[ing] something with yourself". Neither can you equate not having a job to not "do[ing] something with yourself". As always, situations (especially in the macro) are complex and subtle and solutions can't be boiled down to a simple directive. Adults < 26 are often not the ones responsible for not being able to obtain a job. Yes, they may have chosen a field of study that's not in demand (even though many were probably told to "do what you love"), but they've also likely had very little opportunity to impact things like domestic economic policy, employment trends, or even employers not recognizing shifts in demographically driven skill-sets. > * Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. In a system where much (most?) health insurance is provided as an employer paid benefit, why should my employer get to decide whether I'm opted in or out of a particular thing based on religion? Ideally (from my point of view), religion plays zero part in health care. What is wrong with a benefit being available to all and only used by those that want to use it? Is this so different from the "in the privacy of my own bedroom" argument?
- spoiledtechie 10y ago
  Religion plays a part in birth control, especially for the forms of control that kill after inception. Think on it.
  - tacomonstrous 10y ago
    Why should religious belief get any privileged position in this matter?
    - AnimalMuppet 10y ago
      If you're running over someone's conscience on a matter involving human life and death, why do you care that their conscience is based on religion? Personally, if someone is morally opposed to what they perceive as killing, I don't care if their morals are based on religion, atheism, or just squeamishness. Preserve their moral objection to killing. It's too valuable to society for us to trample on it.
anu7df 10y ago
I am sorry but your plan would result in people with preexisting conditions not being able to get coverage. The premium increase would make preexisting conditions insurance unaffordable for most people. Also realize that the system ends up bearing part of the cost any way because they would ultimately end up in the ER without insurance. Does the Republican tenant then support throwing people out on the streets without even emergency care? I only ask because most Republicans seem to think the poor are poor out of choice and should suffer the consequences of being poor. No one seems to understand that preexisting coverage without universal mandate is infeasible.
- serge2k 10y ago
  > because most Republicans seem to think the poor are poor out of choice and should suffer the consequences of being poor Of course. What part of > but damnit kid, get a job. Do something with yourself did you not understand.
  - adrr 10y ago
    I had a multiple jobs through out college. All were part time, none provided health benefits. Our economy is switching from full time employment to a gig based(lyft,postmates,uber). How do contract workers get health insurance?
    - spoiledtechie 10y ago
      The same way they always did before the ACA.
serge2k 10y ago
> but damnit kid, get a job. Do something with yourself. I graduated just before 25, and my first job didn't have benefits because although I was working 40 hours they called it casual. > Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. No, you shouldn't have the right to decide what your employees get to do with their health care. You don't have the right to decide who they sleep with and how. This is the theocratic, forcing my bullshit voodoo beliefs onto others crap that makes the republican party so repugnant.
- AnimalMuppet 10y ago
  Not quite so fast. If it's their healthcare, paid for with their money, then you have a point. If it's "their" healthcare, but paid for with my (the employer's) money, and I have moral objections to abortion and birth control, but you're going to require me to pay for it anyway? Who's forcing their beliefs on others now?
  - serge2k 10y ago
    Do you also place restrictions on what they can buy with their paychecks?
    - AnimalMuppet 10y ago
      You sound like you are deliberately trying to ignore my point, and just want to argue. Just in case you missed it, though: Paychecks are their money. Now, I'll ask again. Are you going to place restrictions on what I (the business owner) buy with my money?
      - serge2k 10y ago
        No, paychecks are compensation given by you to them in exchange for work performed. Health care benefits are also part of that compensation. Why should you have any say in how your employee uses that compensation. Your employees use of their health care plan is none of your damn business. Trying to use health care to regulate their behaviour based on your religious views is a particularly nasty form of oppression.
Goronmon 10y ago
>Preexisting conditions cannot be denied and should be slightly elevated costs compared to the average user. If pre-existing conditions can't be denied, and insurance can't be mandated, how do you prevent people from only picking up insurance when they get sick/hurt?
- spoiledtechie 10y ago
  Because I still have insurance even when I'm healthy. It already exists.
auganov 10y ago
The preexisting conditions ban is what messes up the math of affordable healthcare. Or any minimum coverage provisions for that matter. Either you'll pay for it anyways in subsidies or it's going to effectively outlaw health insurance (not enough people are going to want it).
wishinghand 10y ago
> We should be able to opt out paying for it, especially if it goes against my religion and frankly it does First, separation of church and state, your faith doesn't get to be part of government decisions. Second, do Jehovah's Witnesses get to not pay for blood transfusions in other people? And before you cite that blood transfusions are far more necessary, I think you should hold fast to your fiscal conservative tenets and help prevent unwanted burdens on the state from being born.
alkonaut 10y ago
Making sure citizens are as healthy as possible while paying as little as possible (as a population) seems to me like exactly one of the things a government should be doing. I think the problem is that healthcare after years of this broken system is now seen as private consumption rather than a public interest (like infrastructure and basic education).
verisimilidude 10y ago
> I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. Complete overreach and strictly unconstitutional. Well, let's put that to the test. I consider myself pretty liberal. Here's what I think about your bullet list. * Re: individual mandate I actually agree with you very strongly on this. When the government wants to force me to pay for something, there's already a long-established way to do that: taxes, with services rendered by the government and thus fully accountable to the people. Forcing us to pay for private services sounds awfully similar to forcing us to pay for British tea, which isn't supposed to be how our country works. If the government wants to force us to pay for health insurance, they should tax us and provide universal coverage. * Preexisting conditions cannot be denied and should be slightly elevated costs compared to the average user. Agreed on preexisting conditions, disagreed on higher costs for the affected. "Slightly" quickly becomes a loophole that enables "outrageous". And anyone who lives long enough will eventually acquire a condition anyway. Seems kinda redundant to optimize for that. Just distribute the cost evenly with the understanding that everyone will eventually receive the benefit. * Age 26 under the parents health care plan, fine, but damnit kid, get a job. Do something with yourself. That's what the original post is about. When kids have health care, it's easier for them to make their own jobs instead of going out and begging someone else for them. Sounds like a win for this audience on HN, no? * Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. The goal of health-related regulation should be to improve health-related access and outcomes. There is no question, based on data, that birth control improves women's health, allows them to finish school or further their careers in greater numbers, and eventually increases their lifetime earnings potential, which of course contributes back. If you make exceptions for people's precious feelings, you're looking at an awfully slippery slope. I envision a bunch of assholes declaring that they will opt out of vaccines for religious reasons, then everyone else starts opting out of paying for vaccines and, well, hello again Mr. Measles. No, terrible idea. You don't have to like the latest military campaign to acknowledge the need to pay for a military, and likewise, you don't need to approve of the way others behave to acknowledge the social benefits of birth control. * Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. Sure. * Lastly, I want hospital prices published. I want to shop around. This just doesn't work unless you publish a single price list at the national level and force all health providers to honor that list (Japan). There are two problems. One, sometimes your health needs are too immediate to allow shopping, and you're beholden to whoever happens to pick you up and treat you. If you're bleeding out on the road, you're not gonna stop someone from calling the ambulance just so you can go on yelp and find the best service. Seems like a bad idea to build policy around the assumption that buying health care is like shopping for shampoo. Two, as a person who is likely not a medical professional, you probably wouldn't be able to make sense of any such price list with respect to your needs. Any such list would be detailed beyond the common person's understanding (see Japan), and anyway, you would need to seek diagnosis to know what to pay for in the first place.
dmode 10y ago
Basically you want the ACA. Don't you think if all those things were possible without the mandate, people would have chosen it ? Let's face it, it is not possible to cover pre-existing conditions, children till 26, and poor people without expanding the insured pool dramatically
jsymolon 10y ago
> Remove the boundries of the state borders. This is regulation. Yep, and I hope it's to prevent "lowest common bidder" syndrome on plans. Why does Delaware get all the Corps? Why does a East Texas Court get all the patent cases ? Frankly, my Texas health care plan sucks. Doesn't cover "anything". > Lastly, I want hospital prices published. I want to shop around. Can't shop around in an ambulance.
kmicklas 10y ago
> Now that thats out of the way. I like this self awareness :) > No where in the constitution does it say the government is allowed to force law abiding citizens to do something. Nowhere does it say it's not? Surely you see the mistake in this reasoning. > We should be able to opt out paying for it, especially if it goes against my religion and frankly it does Too bad. You can't force your shitty beliefs onto others. > This is regulation. You say that as if regulations are bad. This particular one probably is though. > I am business friendly, but these are common sense laws. Ah yes, I forgot that common sense means hating poor people. > I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. Complete overreach and strictly unconstitutional. Okay at this point I'm beginning to think you're trolling. This is too much of a Republican caricature.
jartelt 10y ago
It's constitutional because it's a tax and the government is allowed to tax its citizens. You can either buy health insurance to fulfill the tax or you can pay the fine to fulfill the tax. Also, as many people have said, you just picked all the good parts of the ACA and said you want to keep those. It doesn't work that way. In order to get those good things, you need healthy people signed up. The only way to get a lot of healthy people signed up is to mandate insurance.
- spoiledtechie 10y ago
  It's unconstitutional, because it requires you to have health insurance. Try again. Government mandate equals wrong. Healthy people already sign up for it. Go look at the math before the aca.

beatpanda 10y ago

How did you just read a long list of young entrepreneurs who were enabled and encouraged to start businesses because of having their healthcare covered, and you're still writing dumb shit like "GET A JOB!!"?

spoiledtechie 10y ago
Because they are in fact living off the backs of their parents. They are in fact living off the money that was funded to them by people who earned that money. Either ask for more money, or work your way through it. Its not too hard.
- FalcorTheDog 10y ago
  I know right? I can't believe poor people don't just ask for more money. Then they wouldn't have to be poor! It's so simple!

mschuster91 10y ago

> I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. The problem with this POV is that young, healthy people end up having no insurance and thus leave the older, unhealthier population to pay all the bills, whereas a full-insured population would distribute the financial load. Also, it would lead to young, healthy people foregoing insurance in order to save money, and then when catastrophes happen (you're talking about living on the land, so imagine something as harmless as scratching yourself on rusty farm equipment, being bitten by an animal... both can send you to the hospital for weeks!), these people would face financial ruin. The purpose of mandatory healthcare thus is to protect elderly or otherwise pre-conditioned people from having to pay devastatingly high premiums, and to protect people literally from their own short-sightedness.

spoiledtechie 10y ago
Ever heard of an HSA?
- mschuster91 10y ago
  By what I read (admittedly, on Wikipedia, I'm not US-based), a HSA is voluntary and so subject to the same problem that young, healthy people will skip payments. Also, if there's only 50k in the account and the bill is 100k, you're still straight screwed.

JonFish85 10y ago

>> * Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. I think this is something that a lot of small-government conservatives don't want--it's moving responsibilities from the state governments to the federal government.

spoiledtechie 10y ago
There is no responsibility of healthcare by the states or federal if you remove this. Just medicare and medicaid.
- matthewmcg 10y ago
  Incorrect--both insurers and providers are regulated primarily at the state level. Allowing insurers to sell across state lines would be a federal action overriding state sovereignty which is typically not thought of as a "conservative" position.
  - mullen 10y ago
    I also can't imagine that would be constitutional either.
  - spoiledtechie 10y ago
    Right. So stop the state regulation. Mission accomplished and welcome to my way of thinking!

wrsh07 10y ago

1) The government forces law abiding citizens to pay taxes, get vaccines, educate their children, etc... 2) Sam Altman agrees with you that it's okay to repeal it as long as we maintain the best parts of it. > "If Congress ends up repealing it, I hope they earnestly try to preserve the best parts, and put in place something better." We have to start somewhere. The provision about preexisting conditions, and by extension the ACA, is literally life-saving.

spoiledtechie 10y ago
Death and Taxes. Not Death, healthcare, vaccines, education. The government doesn't require me to get vaccines. Nor does it require me to educate my children.
- AnimalMuppet 10y ago
  I agree with you on vaccines. I'm not sure, legally, that you are correct about education (look into truancy laws). Now, you can homeschool if you choose, or place your children in a private school. But I'm not sure, legally, that you can leave them completely uneducated.
  - wrsh07 10y ago
    State laws require certain vaccines [with exemptions] before you attend school: https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.ht... Private schools can also require vaccines. These are good things. We want people to be vaccinated and literate. We want everyone to be able to receive medical care. In the US, that means we want everyone to be insured.
- dragonwriter 10y ago
  > Death and Taxes. Not Death, healthcare, vaccines, education. Well, correct as far as healthcare goes, even with the ACA "mandate". You can choose not to get insurance, and you get some extra taxes in return.

yincrash 10y ago

Do you think it's okay to wait for a replacement after repeal, or come up with changes / replacement before repealing?

rm_-rf_slash 10y ago

In general you make good points, but I am curious about a few potential gaps: 1: If people choose not to get health insurance and then have to go to the ER, who pays for that? You and me. In most cases, it is cheaper for people to get preventative care and reduce their chances of a very expensive ER visit. 2: Preexisting conditions. Sure, but without a guaranteed customer base supported by subsidies then those people will be effectively denied insurance by having to pay insane premiums and deductibles. I have seen no evidence thus far that effectively counters this argument. Lastly, you say you want to live off the land in some small town somewhere and you don't want the government to force you to pay for other people. Splendid! Say hello to Thomas Jefferson for me. But who builds the roads that lead to your house? What about utilities, water, internet? If you slip and fall down the stairs and break your leg who do you call, 911? If so, who pays for the 911 service, let alone the ambulance to take you to the hospital? Again, I do agree with your premise, but since in my experience most libertarian arguments tend to crack under the pressure of public goods (like national security), where do you draw the line between independence and the needs of the populace as a whole?

spoiledtechie 10y ago
1. Like ALL companies, which a hospital is, They can write it off, but ALSO they allocate that already into their budget..... All companies have expected losses. What gives the right of the govt to take charge of hospitals and say otherwise. All companies have expected losses and they allocate those into their budget. 2. Then prices will increase within each insurance company and as a user, I will pay for the insurance I want, rather than be forced. 3. Oh Stop. I didn't say I wouldn't pay taxes. When did Healthcare become a government problem, rather than something that can be done through businesses. Its a business! If you can't afford to pay the bills then work a little harder to do something better with your life.

stinkytaco 10y ago

Your solutions rely on something that does not exist in health care: information parity. A true free market requires information parity. Health care is complicated, thus information parity does not exist. Regulation is the answer to dealing with that lack of information parity. A hospital cannot "publish prices" because prices vary wildly based on many factors. Even if they did, how am I supposed to know what I need for my healthcare? If I go to the doctor and they say "you need a surgery and it will cost 10,000" the posted prices do not tell me if I need that surgery at all, just what they cost. And, of course, the most expensive medical care is emergency, a time when price shopping is not possible. > Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. I'm not opposed to this, but it does remove state control over insurance regulation, which is an anathama to Republicans. I also have no idea how it will drive down costs? Are some states that much healthier than others? > Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. I don't even know where to start. If I can opt out of paying for some medically approved procedures, where does it end? Can I say that I want to opt out of ob/gyn care for unmarried women?

bzbarsky 10y ago
> A hospital cannot "publish prices" because prices vary wildly based on many factors. Here's a question: Dentists routinely publish prices. If you ask them how much some procedure will cost, they will tell you. If there is uncertainty, they will give you a range (e.g. to account for the possibility that complications will arise during an oral surgery). What is different in the hospital situation, apart from some rather extreme measures taken to obfuscate pricing? > And, of course, the most expensive medical care is emergency Is it? Or is it end-of-life? Genuinely curious to see numbers here! > I also have no idea how it will drive down costs Prices, not costs. The current situation is that in a lot of states there are somewhere on the order of 1-3 companies offering insurance of certain types at all. For example, for Maryland, I believe there is only one company offering an ACA-compatible PPO (everyone else has HMOs or even EPOs). See https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 for where I got that data. Of course in a monopoly situation there is absolutely no incentive for a monopolist to cut prices. Why would they? So to the extent that prices represent excessive profits (as opposed to the actual costs of health care), allowing cross-state insurance sales should drive them down. People who believe insurance companies are price-gouging should be _very_ in favor of removing restrictions on such sales.

tasty_freeze 10y ago

> We should be able to opt out paying for it, especially if it goes against my religion and frankly it does Does this exception generalize? From the start, I felt it was immoral to go into Iraq, topple the government, get 4000+ US soldiers killed and cause the deaths of hundreds of thousands of Iraqis. The pennies you pay for birth control a nothing compared to what I as compelled to pay for a war I didn't support from the get go. Can I get my money back for that one? I'm sure my objection to it is/was as sincere and deeply felt as your objection to birth control.

spoiledtechie 10y ago
Its not about my pennies. Its about my faith.
- noobermin 10y ago
  I don't know if you realized it, but you are close to saying "government should tighten its belt unless it's stuff I believe in". Then, both sides can make the argument, and there is never any deficit reduction, we keep spending on things we want.
- serge2k 10y ago
  It's about trying to impose your faith on others. Do you not realize how awful that is? How much of a hypocrite it makes you to hide behind freedom of religion as a means to try to force your religious beliefs on others? Especially via their health care. How would you feel about tying health in to praying to Mecca multiple times a day? How about if you work on the sabbath you lose your coverage? Divorced? No health care for you sinner. STD coverage should probably be banned. I mean sure, there are other ways to get AIDS but if you were having sex in a nice normal marriage then you probably wouldn't get it.
  - spoiledtechie 10y ago
    Imposing my faith on others. Disagree. They impose birth control on me.

nantes 10y ago

Apologies in advance for cherry-picking points to respond to, but ... > * Age 26 under the parents health care plan, fine, but damnit kid, get a job. Do something with yourself. I don't think you can simply equate having a job to "do[ing] something with yourself". Neither can you equate not having a job to not "do[ing] something with yourself". As always, situations (especially in the macro) are complex and subtle and solutions can't be boiled down to a simple directive. Adults < 26 are often not the ones responsible for not being able to obtain a job. Yes, they may have chosen a field of study that's not in demand (even though many were probably told to "do what you love"), but they've also likely had very little opportunity to impact things like domestic economic policy, employment trends, or even employers not recognizing shifts in demographically driven skill-sets. > * Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. In a system where much (most?) health insurance is provided as an employer paid benefit, why should my employer get to decide whether I'm opted in or out of a particular thing based on religion? Ideally (from my point of view), religion plays zero part in health care. What is wrong with a benefit being available to all and only used by those that want to use it? Is this so different from the "in the privacy of my own bedroom" argument?

spoiledtechie 10y ago
Religion plays a part in birth control, especially for the forms of control that kill after inception. Think on it.
- tacomonstrous 10y ago
  Why should religious belief get any privileged position in this matter?
  - AnimalMuppet 10y ago
    If you're running over someone's conscience on a matter involving human life and death, why do you care that their conscience is based on religion? Personally, if someone is morally opposed to what they perceive as killing, I don't care if their morals are based on religion, atheism, or just squeamishness. Preserve their moral objection to killing. It's too valuable to society for us to trample on it.

anu7df 10y ago

I am sorry but your plan would result in people with preexisting conditions not being able to get coverage. The premium increase would make preexisting conditions insurance unaffordable for most people. Also realize that the system ends up bearing part of the cost any way because they would ultimately end up in the ER without insurance. Does the Republican tenant then support throwing people out on the streets without even emergency care? I only ask because most Republicans seem to think the poor are poor out of choice and should suffer the consequences of being poor. No one seems to understand that preexisting coverage without universal mandate is infeasible.

serge2k 10y ago
> because most Republicans seem to think the poor are poor out of choice and should suffer the consequences of being poor Of course. What part of > but damnit kid, get a job. Do something with yourself did you not understand.
- adrr 10y ago
  I had a multiple jobs through out college. All were part time, none provided health benefits. Our economy is switching from full time employment to a gig based(lyft,postmates,uber). How do contract workers get health insurance?
  - spoiledtechie 10y ago
    The same way they always did before the ACA.

serge2k 10y ago

> but damnit kid, get a job. Do something with yourself. I graduated just before 25, and my first job didn't have benefits because although I was working 40 hours they called it casual. > Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. No, you shouldn't have the right to decide what your employees get to do with their health care. You don't have the right to decide who they sleep with and how. This is the theocratic, forcing my bullshit voodoo beliefs onto others crap that makes the republican party so repugnant.

AnimalMuppet 10y ago
Not quite so fast. If it's their healthcare, paid for with their money, then you have a point. If it's "their" healthcare, but paid for with my (the employer's) money, and I have moral objections to abortion and birth control, but you're going to require me to pay for it anyway? Who's forcing their beliefs on others now?
- serge2k 10y ago
  Do you also place restrictions on what they can buy with their paychecks?
  - AnimalMuppet 10y ago
    You sound like you are deliberately trying to ignore my point, and just want to argue. Just in case you missed it, though: Paychecks are their money. Now, I'll ask again. Are you going to place restrictions on what I (the business owner) buy with my money?
    - serge2k 10y ago
      No, paychecks are compensation given by you to them in exchange for work performed. Health care benefits are also part of that compensation. Why should you have any say in how your employee uses that compensation. Your employees use of their health care plan is none of your damn business. Trying to use health care to regulate their behaviour based on your religious views is a particularly nasty form of oppression.

Goronmon 10y ago

>Preexisting conditions cannot be denied and should be slightly elevated costs compared to the average user. If pre-existing conditions can't be denied, and insurance can't be mandated, how do you prevent people from only picking up insurance when they get sick/hurt?

spoiledtechie 10y ago
Because I still have insurance even when I'm healthy. It already exists.

auganov 10y ago

The preexisting conditions ban is what messes up the math of affordable healthcare. Or any minimum coverage provisions for that matter. Either you'll pay for it anyways in subsidies or it's going to effectively outlaw health insurance (not enough people are going to want it).

wishinghand 10y ago

> We should be able to opt out paying for it, especially if it goes against my religion and frankly it does First, separation of church and state, your faith doesn't get to be part of government decisions. Second, do Jehovah's Witnesses get to not pay for blood transfusions in other people? And before you cite that blood transfusions are far more necessary, I think you should hold fast to your fiscal conservative tenets and help prevent unwanted burdens on the state from being born.

alkonaut 10y ago

Making sure citizens are as healthy as possible while paying as little as possible (as a population) seems to me like exactly one of the things a government should be doing. I think the problem is that healthcare after years of this broken system is now seen as private consumption rather than a public interest (like infrastructure and basic education).

verisimilidude 10y ago

> I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. Complete overreach and strictly unconstitutional. Well, let's put that to the test. I consider myself pretty liberal. Here's what I think about your bullet list. * Re: individual mandate I actually agree with you very strongly on this. When the government wants to force me to pay for something, there's already a long-established way to do that: taxes, with services rendered by the government and thus fully accountable to the people. Forcing us to pay for private services sounds awfully similar to forcing us to pay for British tea, which isn't supposed to be how our country works. If the government wants to force us to pay for health insurance, they should tax us and provide universal coverage. * Preexisting conditions cannot be denied and should be slightly elevated costs compared to the average user. Agreed on preexisting conditions, disagreed on higher costs for the affected. "Slightly" quickly becomes a loophole that enables "outrageous". And anyone who lives long enough will eventually acquire a condition anyway. Seems kinda redundant to optimize for that. Just distribute the cost evenly with the understanding that everyone will eventually receive the benefit. * Age 26 under the parents health care plan, fine, but damnit kid, get a job. Do something with yourself. That's what the original post is about. When kids have health care, it's easier for them to make their own jobs instead of going out and begging someone else for them. Sounds like a win for this audience on HN, no? * Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. The goal of health-related regulation should be to improve health-related access and outcomes. There is no question, based on data, that birth control improves women's health, allows them to finish school or further their careers in greater numbers, and eventually increases their lifetime earnings potential, which of course contributes back. If you make exceptions for people's precious feelings, you're looking at an awfully slippery slope. I envision a bunch of assholes declaring that they will opt out of vaccines for religious reasons, then everyone else starts opting out of paying for vaccines and, well, hello again Mr. Measles. No, terrible idea. You don't have to like the latest military campaign to acknowledge the need to pay for a military, and likewise, you don't need to approve of the way others behave to acknowledge the social benefits of birth control. * Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. Sure. * Lastly, I want hospital prices published. I want to shop around. This just doesn't work unless you publish a single price list at the national level and force all health providers to honor that list (Japan). There are two problems. One, sometimes your health needs are too immediate to allow shopping, and you're beholden to whoever happens to pick you up and treat you. If you're bleeding out on the road, you're not gonna stop someone from calling the ambulance just so you can go on yelp and find the best service. Seems like a bad idea to build policy around the assumption that buying health care is like shopping for shampoo. Two, as a person who is likely not a medical professional, you probably wouldn't be able to make sense of any such price list with respect to your needs. Any such list would be detailed beyond the common person's understanding (see Japan), and anyway, you would need to seek diagnosis to know what to pay for in the first place.

dmode 10y ago

Basically you want the ACA. Don't you think if all those things were possible without the mandate, people would have chosen it ? Let's face it, it is not possible to cover pre-existing conditions, children till 26, and poor people without expanding the insured pool dramatically

jsymolon 10y ago

> Remove the boundries of the state borders. This is regulation. Yep, and I hope it's to prevent "lowest common bidder" syndrome on plans. Why does Delaware get all the Corps? Why does a East Texas Court get all the patent cases ? Frankly, my Texas health care plan sucks. Doesn't cover "anything". > Lastly, I want hospital prices published. I want to shop around. Can't shop around in an ambulance.

kmicklas 10y ago

> Now that thats out of the way. I like this self awareness :) > No where in the constitution does it say the government is allowed to force law abiding citizens to do something. Nowhere does it say it's not? Surely you see the mistake in this reasoning. > We should be able to opt out paying for it, especially if it goes against my religion and frankly it does Too bad. You can't force your shitty beliefs onto others. > This is regulation. You say that as if regulations are bad. This particular one probably is though. > I am business friendly, but these are common sense laws. Ah yes, I forgot that common sense means hating poor people. > I think EVERY Republican can get behind these thoughts as every other Democrat, but forcing me to pay for it, when I just want to live off the land in some small town somewhere. Complete overreach and strictly unconstitutional. Okay at this point I'm beginning to think you're trolling. This is too much of a Republican caricature.

jartelt 10y ago

It's constitutional because it's a tax and the government is allowed to tax its citizens. You can either buy health insurance to fulfill the tax or you can pay the fine to fulfill the tax. Also, as many people have said, you just picked all the good parts of the ACA and said you want to keep those. It doesn't work that way. In order to get those good things, you need healthy people signed up. The only way to get a lot of healthy people signed up is to mandate insurance.

spoiledtechie 10y ago
It's unconstitutional, because it requires you to have health insurance. Try again. Government mandate equals wrong. Healthy people already sign up for it. Go look at the math before the aca.