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I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of

I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of people insured, but that doesn't really capture how well insured they are. Life expectancy seems to be the only well known (at least to me) stat that begins to capture the health of the nation. We've now had 3 straight years of declining life expectancy in the US [0], a single year is virtually unheard of in developed nations. Now there are lots of confounding variables, and it's certainly not possible to say the ACA is the cause. And 3 years of downward trend, isn't historically unprecedented. However, it certainly makes it hard to paint the ACA as a success, I'd want to see some compelling evidence that the ACA had made America healthier, which doesn't exist right now. The question to me is how long we can accept a downward life expectancy trend before we start looking at the ACA as a potential cause. [0] https://www.smithsonianmag.com/smart-news/us-life-expectancy-drops-third-year-row-reflecting-rising-drug-overdose-suicide-rates-180970942/ https://www.smithsonianmag.com/smart-news/us-life-expectancy...

stronglikedan 7y ago
A good metric is - did it do what it was designed to do? I think the answer is yes. It was designed to be an unsustainable failure, in order to trick people into thinking single-payer was the next best thing. In that regard, it has been a resounding success.
LarryDarrell 7y ago
I hate on the ACA as much as the next guy, but the article you linked blames drug overdoses and suicides. For that I would blame the for-profit health care system pushing opioids and the (Great Recession + inadequacy of our mental health care system). To blame that on a law that sought to eliminate preexisting conditions and to establish a baseline as to what a health insurance plan ought to provide seems like a stretch. Having a free yearly physical isn't going to help your crushing depression and economic anxieties.
- jdoliner 7y ago
  I was just linking that as a reference for the declining life expectancy. I don't think they even come close to establishing opioid and suicide deaths as the cause, that's just journalistic conjecture. If you look at the number of opioid and suicide related deaths it's very small compared to the total population of the US, so the math just doesn't seem to work out for me. I remember an HN comment a while ago that worked out how many deaths you'd need from those causes to lower the life expectancy as much as we're seeing and it was a lot higher than what we're seeing now. Unfortunately I can't seem to unearth the comment.
  - FireBeyond 7y ago
    Apropos of anything else, as of 2019, you are more likely to die of an opiate overdose (accidental or deliberate) than you are in an MVA. That's staggering. Of course, not unexpected in a country that has 3% of the world populace but 81% of the world's opiate use.

stronglikedan 7y ago

A good metric is - did it do what it was designed to do? I think the answer is yes. It was designed to be an unsustainable failure, in order to trick people into thinking single-payer was the next best thing. In that regard, it has been a resounding success.

LarryDarrell 7y ago

I hate on the ACA as much as the next guy, but the article you linked blames drug overdoses and suicides. For that I would blame the for-profit health care system pushing opioids and the (Great Recession + inadequacy of our mental health care system). To blame that on a law that sought to eliminate preexisting conditions and to establish a baseline as to what a health insurance plan ought to provide seems like a stretch. Having a free yearly physical isn't going to help your crushing depression and economic anxieties.

jdoliner 7y ago
I was just linking that as a reference for the declining life expectancy. I don't think they even come close to establishing opioid and suicide deaths as the cause, that's just journalistic conjecture. If you look at the number of opioid and suicide related deaths it's very small compared to the total population of the US, so the math just doesn't seem to work out for me. I remember an HN comment a while ago that worked out how many deaths you'd need from those causes to lower the life expectancy as much as we're seeing and it was a lot higher than what we're seeing now. Unfortunately I can't seem to unearth the comment.
- FireBeyond 7y ago
  Apropos of anything else, as of 2019, you are more likely to die of an opiate overdose (accidental or deliberate) than you are in an MVA. That's staggering. Of course, not unexpected in a country that has 3% of the world populace but 81% of the world's opiate use.