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As much as dissapointment the Affordable Care Act was, at least someone tried something. If only we could learn from those mistakes and make incremental changes

As much as dissapointment the Affordable Care Act was, at least someone tried something. If only we could learn from those mistakes and make incremental changes. Politicians are to obsessed with either tearing it all down or healthcare for all for "free", no middle ground

stephengillie 8y ago
We have a single-payer system - Medicare. ACA is just a jobs program for the insurance industry, perpetuating 2 types of bullshit jobs: medical billing and medical underwriting.
- nradov 8y ago
  Medical "insurance" companies actually don't do much underwriting any more. Most policies are self insured by large employers. The insurance company just manages the provider network and administers claims. Even medical billing is gradually going away with the shift to value-based care and accountable care organizations (ACOs).
Frondo 8y ago
Not free and no one's saying that. Free at point of service, like the NHS or the Canadian health care system, yes, but obviously everyone knows we'd pay for it with taxes. We could just do it, cover everyone, for less than we're paying now, by rejiggering the system under a "medicare for all" banner. There aren't any other serious options on the table. (replace and repeal, or whatever, is not a serious option.)
- ssambros 8y ago
  Medicare currently pays less than what it costs to provide for a lot of services. And providers are either declining medicare alltogether or recouping the missing funds from the other patients. Where would all those other patients come from if medicare will be "for all"?
  - maxxxxx 8y ago
    "Medicare currently pays less than what it costs to provide for a lot of services" Is that even true? Personally I have my doubts.
    - ssambros 8y ago
      American Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0] FINDINGS In the aggregate, both Medicare and Medicaid payments fell below costs in 2016: - Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid. -For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2016. - For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016. - In 2016, 66 percent of hospitals received Medicare payments less than cost, while 61 percent of hospitals received Medicaid payments less than cost. [0] https://www.aha.org/data-insights/2018-01-03-underpayment-medicare-and-medicaid-fact-sheet-december-2017-update https://www.aha.org/data-insights/2018-01-03-underpayment-me...
      - maxxxxx 8y ago
        After having dealt with billing from hospitals for services they never delivered or obscenely overpriced I am inclined not to trust them on statements about their actual cost. In my view the billing practices of most hospitals are very dishonest and intentionally confusing and opaque.
        ssambros 8y ago
        "billing practices of most hospitals are very dishonest and intentionally confusing and opaque." Is that even true? Personally I have my doubts.
        maxxxxx 8y ago
        Check out some hospital bills for major procedures and there is a good chance that you will find things like charges for services nobody remembers or a doctor who was in the room for 3 minutes charged $1200 or receiving an aspirin costs $80. Maybe my experiences are all anecdotal but when I put my own experiences together with what I hear from others and things I read I am pretty convinced that something is going very wrong.
- frockington 8y ago
  As a taxpayer I would be in favor of a more equitable system where everyone has a line item brought to their attention. There may be a use case for UBI here, everyone gets a stipend or a tax cut that they can use to either get healthcare or not. I'm getting tired of all of the taxes and how easy it is to paint tax payers as evil rich people who need to give more with their hard earned money
ahoy 8y ago
The ACA was the middle ground and it's still bad.
- frockington 8y ago
  I agree with you, I'm saying we should learn from the mistakes and iterate on the current instead of fighting for extremes that will never work or be passed
  - maxxxxx 8y ago
    One thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.
    - rectang 8y ago
      While I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.) I would have liked to see more experimentation on price transparency.
      - maxxxxx 8y ago
        Totally agree about price transparency. Everybody but the people in the medical system who benefit from opaque pricing should be able to agree with this. I don't think my comment was partisan but it was a description of the last 10 years. Republicans voted to repeal Obamacare several times a year but never introduced anything for improving it. And now that they are in power they seem have no idea how to proceed. I am not saying that Obamacare was a good law. Actually it was pretty half assed but it could probably be made to work with some changes. I would have loved it opponents of it would have introduced steps for improvement but they never did.
        rectang 8y ago
cmurf 8y ago
PPACA is the incremental change. There wasn't the political capital to effectively destroy the health insurance industry by leaving only VIP insurance (really it's not insurance, it's a "pay extra to cut in front of the line" product). Democrats apparently didn't have the votes to even make Medicare or Medicaid an optional buy-in, to compete with marketplace insurance. This in particular is necessary in a huge land area of the U.S. where there's only one or two insurance providers.
- masonic 8y ago
  Democrats apparently didn't have the votes Democrats had the only votes and the only say in every element of "Obamacare". Republicans were not even allowed to see the bill before the vote was taken, hence zero Republicans voting for it.
  - dragonwriter 8y ago
    > Democrats had the only votes and the only say in every element of "Obamacare". That's not actually true (Republicans had a significant say, even though thet universally ended up voting no), but even if it was the public option had long been controversial among Democratic politicians despite it (and even moreso simple single payer, which had a majority support ) long being overwhelmingly popular among Democrstic voters and having stronger support nationally than the purchase mandate w/o public option approach. > Republicans were not even allowed to see the bill before the vote was taken, Yeah, they were, they were also involved in the Committee process in the Senate in which it was drafted. They also filibustered it for quite a while, which gave them even more time in which to read it. And of course Republicans in the House had still more time to read it, since it was voted on in the House after the vote in the Senate. There are lots of reasons you can argue might have been behind Republicans voting against, not being allowed to read it is not one of them.

stephengillie 8y ago

We have a single-payer system - Medicare. ACA is just a jobs program for the insurance industry, perpetuating 2 types of bullshit jobs: medical billing and medical underwriting.

nradov 8y ago
Medical "insurance" companies actually don't do much underwriting any more. Most policies are self insured by large employers. The insurance company just manages the provider network and administers claims. Even medical billing is gradually going away with the shift to value-based care and accountable care organizations (ACOs).

Frondo 8y ago

Not free and no one's saying that. Free at point of service, like the NHS or the Canadian health care system, yes, but obviously everyone knows we'd pay for it with taxes. We could just do it, cover everyone, for less than we're paying now, by rejiggering the system under a "medicare for all" banner. There aren't any other serious options on the table. (replace and repeal, or whatever, is not a serious option.)

ssambros 8y ago
Medicare currently pays less than what it costs to provide for a lot of services. And providers are either declining medicare alltogether or recouping the missing funds from the other patients. Where would all those other patients come from if medicare will be "for all"?
- maxxxxx 8y ago
  "Medicare currently pays less than what it costs to provide for a lot of services" Is that even true? Personally I have my doubts.
  - ssambros 8y ago
    American Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0] FINDINGS In the aggregate, both Medicare and Medicaid payments fell below costs in 2016: - Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid. -For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2016. - For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016. - In 2016, 66 percent of hospitals received Medicare payments less than cost, while 61 percent of hospitals received Medicaid payments less than cost. [0] https://www.aha.org/data-insights/2018-01-03-underpayment-medicare-and-medicaid-fact-sheet-december-2017-update https://www.aha.org/data-insights/2018-01-03-underpayment-me...
    - maxxxxx 8y ago
      After having dealt with billing from hospitals for services they never delivered or obscenely overpriced I am inclined not to trust them on statements about their actual cost. In my view the billing practices of most hospitals are very dishonest and intentionally confusing and opaque.
      - ssambros 8y ago
        "billing practices of most hospitals are very dishonest and intentionally confusing and opaque." Is that even true? Personally I have my doubts.
        maxxxxx 8y ago
        Check out some hospital bills for major procedures and there is a good chance that you will find things like charges for services nobody remembers or a doctor who was in the room for 3 minutes charged $1200 or receiving an aspirin costs $80. Maybe my experiences are all anecdotal but when I put my own experiences together with what I hear from others and things I read I am pretty convinced that something is going very wrong.
frockington 8y ago
As a taxpayer I would be in favor of a more equitable system where everyone has a line item brought to their attention. There may be a use case for UBI here, everyone gets a stipend or a tax cut that they can use to either get healthcare or not. I'm getting tired of all of the taxes and how easy it is to paint tax payers as evil rich people who need to give more with their hard earned money

ahoy 8y ago

The ACA was the middle ground and it's still bad.

frockington 8y ago
I agree with you, I'm saying we should learn from the mistakes and iterate on the current instead of fighting for extremes that will never work or be passed
- maxxxxx 8y ago
  One thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.
  - rectang 8y ago
    While I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.) I would have liked to see more experimentation on price transparency.
    - maxxxxx 8y ago
      Totally agree about price transparency. Everybody but the people in the medical system who benefit from opaque pricing should be able to agree with this. I don't think my comment was partisan but it was a description of the last 10 years. Republicans voted to repeal Obamacare several times a year but never introduced anything for improving it. And now that they are in power they seem have no idea how to proceed. I am not saying that Obamacare was a good law. Actually it was pretty half assed but it could probably be made to work with some changes. I would have loved it opponents of it would have introduced steps for improvement but they never did.
      - rectang 8y ago

cmurf 8y ago

PPACA is the incremental change. There wasn't the political capital to effectively destroy the health insurance industry by leaving only VIP insurance (really it's not insurance, it's a "pay extra to cut in front of the line" product). Democrats apparently didn't have the votes to even make Medicare or Medicaid an optional buy-in, to compete with marketplace insurance. This in particular is necessary in a huge land area of the U.S. where there's only one or two insurance providers.

masonic 8y ago
Democrats apparently didn't have the votes Democrats had the only votes and the only say in every element of "Obamacare". Republicans were not even allowed to see the bill before the vote was taken, hence zero Republicans voting for it.
- dragonwriter 8y ago
  > Democrats had the only votes and the only say in every element of "Obamacare". That's not actually true (Republicans had a significant say, even though thet universally ended up voting no), but even if it was the public option had long been controversial among Democratic politicians despite it (and even moreso simple single payer, which had a majority support ) long being overwhelmingly popular among Democrstic voters and having stronger support nationally than the purchase mandate w/o public option approach. > Republicans were not even allowed to see the bill before the vote was taken, Yeah, they were, they were also involved in the Committee process in the Senate in which it was drafted. They also filibustered it for quite a while, which gave them even more time in which to read it. And of course Republicans in the House had still more time to read it, since it was voted on in the House after the vote in the Senate. There are lots of reasons you can argue might have been behind Republicans voting against, not being allowed to read it is not one of them.