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I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit

I signed up for the ACA the year it came online. Over the years I went from a sub-$100 plan that actually covered things to paying $300+ per month for the "hit by a bus" plan that was so expensive, one year I said fuck it and paid the penalty instead. I understand well what could have been had something truly happened, but I ended up saving money paying the penalty while still having a few minor doc-in-a-box visits out-of-pocket. I also say a number of insurers go out of businesses such that now your only option in my state is the BCBS. Say what you will about the ACA, but requiring folks to purchase a product while doing not curbing the rampant greed in the industry screams of corporate welfare to me.

LarryDarrell 7y ago
It is corporate welfare, I remember lots of libertarian arguments to that very point. But to solve health care in the US you would eventually have to start questioning the for-profit underpinnings of the whole enterprise. That was far too much to expect from the generally pro-market Democrats in office at the time. Even after Bernie Sanders, the "Very Serious Democrats" talk more of protecting the Health Insurance Industry than anything else. Best case, we'll see a timid proposal of a expensive Medicare Buy-In added to the ACA exchange that will never get past the Senate.
- apocalypstyx 7y ago
  As I once heard it put: the US doesn't have a left and a right party, it has two parties to the left and right of capital.
  - mieseratte 7y ago
    I heard it once said that America is a one-party system, but in typical American excess we have two. Both in service of capital.
    - sanderjd 7y ago
      I used to dabble in enjoying quips like this. They're simple and fun and sound insightful and knowing. But when I look around me I see no truth to them. We have two parties with very distinct philosophies making very different arguments for how the future of our culture and economy should function. "Capital" influences both of them, in different, sometimes overlapping, ways. But they have many differences across many axes.
      - mrosett 7y ago
        The "above it all" smugness of quips like that is tiresome.
tptacek 7y ago
If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.
- refurb 7y ago
  The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just ignoring the math.
  - everdev 7y ago
    I had the same experience where as a sole proprietor health insurance for a family of 5 is now $2,000/month. $24k/year not for great healthcare, but for the privilege of paying a "discounted rate" on "select services" when you actually need healthcare. We haven't needed the coverage for two years but when we did, what we needed wasn't covered so we paid full price anyway including $80 for a bottle of Ibuprofen that was casually offered to us. The markups are almost criminal. For a $1M home you can find insurance for $1,500 per year. It's exponentially less expensive. ACA was the worst possible compromise to a serious problem. A public option, universal healthcare or deregulation all would have been better options. It'd be much nicer to be able pay a doctor to make house calls as needed and waive your right to a malpractice lawsuit than to pay to support this insurance/legal/government system we have now.
  - Gibbon1 7y ago
    My companies insurance premiums were going up 10-15% a year for years before the ACA.
    - 7y ago
nobleach 7y ago
When I look at what my insurance company actually covers for all of my doctor bills, I'd probably be better off just paying the penalty. At least I'd have a few hundred more every pay check to cover that 11 extra dollars that my insurance company could dare to part with for a $300 X-Ray.
- tptacek 7y ago
  The penalty has been more or less hamstrung by the GOP, so if that's your only consideration, then, yes, you're better off not paying for health insurance. Additionally: you can (you shouldn't have to, but you can) shop around for cheaper medical imaging. Imaging in particular has wildly varying prices, and if you stay on the "happy path" your PCP and hospital puts you on, you're going to pay the higher end of the range of prices. You are not, as a general matter of life advice, better off going without health insurance. Rather, find the least expensive HSA-qualified HDHP, fund the HSA with the savings, and pay for routine care (effectively) out-of-pocket. The point of insurance isn't to make your annual checkup cheaper, but rather to avoid going bankrupt if you get hit by a car or your appendix bursts. From the way you write, your appendix presumably hasn't burst yet. That's great! Neither has mine! My house has also not caught fire† and I have not managed to crash my car into a fully occupied city bus. But I am insured against both of those things, too. † since we bought it, i mean
  - nobleach 7y ago
    I should probably specify the level of "tongue-in-cheek" in which my dismissive comment was made. I'm well aware of the function of medical (as well as other) insurance. Having a family, I'd be a fool to "go it alone". But you're correct, it's my responsibility, especially as one who chose a HDHP this year, to shop for the best deals. And nope, still on my original appendix... I change the oil regularly.

LarryDarrell 7y ago

It is corporate welfare, I remember lots of libertarian arguments to that very point. But to solve health care in the US you would eventually have to start questioning the for-profit underpinnings of the whole enterprise. That was far too much to expect from the generally pro-market Democrats in office at the time. Even after Bernie Sanders, the "Very Serious Democrats" talk more of protecting the Health Insurance Industry than anything else. Best case, we'll see a timid proposal of a expensive Medicare Buy-In added to the ACA exchange that will never get past the Senate.

apocalypstyx 7y ago
As I once heard it put: the US doesn't have a left and a right party, it has two parties to the left and right of capital.
- mieseratte 7y ago
  I heard it once said that America is a one-party system, but in typical American excess we have two. Both in service of capital.
  - sanderjd 7y ago
    I used to dabble in enjoying quips like this. They're simple and fun and sound insightful and knowing. But when I look around me I see no truth to them. We have two parties with very distinct philosophies making very different arguments for how the future of our culture and economy should function. "Capital" influences both of them, in different, sometimes overlapping, ways. But they have many differences across many axes.
    - mrosett 7y ago
      The "above it all" smugness of quips like that is tiresome.

tptacek 7y ago

If you're saying the ACA didn't completely fix the US healthcare system, I strongly agree. If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.

refurb 7y ago
The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well. That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just ignoring the math.
- everdev 7y ago
  I had the same experience where as a sole proprietor health insurance for a family of 5 is now $2,000/month. $24k/year not for great healthcare, but for the privilege of paying a "discounted rate" on "select services" when you actually need healthcare. We haven't needed the coverage for two years but when we did, what we needed wasn't covered so we paid full price anyway including $80 for a bottle of Ibuprofen that was casually offered to us. The markups are almost criminal. For a $1M home you can find insurance for $1,500 per year. It's exponentially less expensive. ACA was the worst possible compromise to a serious problem. A public option, universal healthcare or deregulation all would have been better options. It'd be much nicer to be able pay a doctor to make house calls as needed and waive your right to a malpractice lawsuit than to pay to support this insurance/legal/government system we have now.
- Gibbon1 7y ago
  My companies insurance premiums were going up 10-15% a year for years before the ACA.
  - 7y ago

nobleach 7y ago

When I look at what my insurance company actually covers for all of my doctor bills, I'd probably be better off just paying the penalty. At least I'd have a few hundred more every pay check to cover that 11 extra dollars that my insurance company could dare to part with for a $300 X-Ray.

tptacek 7y ago
The penalty has been more or less hamstrung by the GOP, so if that's your only consideration, then, yes, you're better off not paying for health insurance. Additionally: you can (you shouldn't have to, but you can) shop around for cheaper medical imaging. Imaging in particular has wildly varying prices, and if you stay on the "happy path" your PCP and hospital puts you on, you're going to pay the higher end of the range of prices. You are not, as a general matter of life advice, better off going without health insurance. Rather, find the least expensive HSA-qualified HDHP, fund the HSA with the savings, and pay for routine care (effectively) out-of-pocket. The point of insurance isn't to make your annual checkup cheaper, but rather to avoid going bankrupt if you get hit by a car or your appendix bursts. From the way you write, your appendix presumably hasn't burst yet. That's great! Neither has mine! My house has also not caught fire† and I have not managed to crash my car into a fully occupied city bus. But I am insured against both of those things, too. † since we bought it, i mean
- nobleach 7y ago
  I should probably specify the level of "tongue-in-cheek" in which my dismissive comment was made. I'm well aware of the function of medical (as well as other) insurance. Having a family, I'd be a fool to "go it alone". But you're correct, it's my responsibility, especially as one who chose a HDHP this year, to shop for the best deals. And nope, still on my original appendix... I change the oil regularly.