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I only wanted to address one thing you mentioned: polling varies widely on abolishing the private insurance system. The Kaiser Family Foundation does extensive

by Frondo 7y ago

I only wanted to address one thing you mentioned: polling varies widely on abolishing the private insurance system. The Kaiser Family Foundation does extensive health care polling on a continual basis, and their recent poll suggests that 37% favor single-payer where private insurance is abolished. Also, there certainly is room -- and I think even the staunchest advocate of socialized medicine acknowledges this -- for elective procedures to be covered by private insurance under a single-payer regime, so it's maybe inaccurate to say that one (single payer) necessitates the other (abolishing private insurance). Several countries I'm aware of split it up that way successfully. Lots of other interesting information here: https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/ https://www.kff.org/slideshow/public-opinion-on-single-payer...

rayiner 7y ago
When people are polled about “private insurance” I don’t think they’re thinking about private insurance for elective procedures. I think the point shows that the large majority of people want, at most, a public option as an alternative to their existing private insurance. And that solution is unlikely to have much impact on costs. At the end of the day, the thing that came out of the political process (ACA plus Medicaid expansion) is probably the closest thing that has been proposed to what people are actually comfortable with.
- jcadam 7y ago
  I'm certainly not comfortable with the ACA. I'm old enough to remember what health insurance was like before Obama came along. The sudden and dramatic increase in premiums, deductibles, and co-insurance was effectively a massive pay cut for the entire American middle class. The government took a bad situation (the US healthcare system) and managed to make it a lot worse.
  - Frondo 7y ago
    Yes and no. Eliminating the pre-existing conditions restrictions was life-changing for me and a lot of people I know; I'd had a surgery in 2005 that, up to whenever Obamacare was passed, excluded me from buying any health insurance from a private insurer. They all declined me as having had a pre-existing condition (having been operated on). Obamacare taking that away? A good thing. The medicaid expansion was significant for several of my friends, too. Suddenly, they qualified for medicaid! Again, big improvement in their quality of life. Lots wrong with the ACA, and for my part I wish we'd had the public option, but overall I don't think it made health care worse; just changed the good and bad to affect different people.
  - runako 7y ago
    I've been buying insurance on the individual & small-group markets for almost 20 years. I've done this across three states. Which is to say I am keenly aware of how much healthcare has cost in both the pre-ACA and post-ACA timeframes. > The sudden and dramatic increase in premiums, deductibles, and co-insurance was effectively a massive pay cut for the entire American middle class. This is just a misrepresentation (or overgeneralization) of facts. One thing that was true before the ACA is that insurance rates increased monotonically every year, often by large percentages. This also applies to deductibles and co-insurance. What changed was compounding. In 2002, a 20% increase on a $150/mo policy added $30 to the price. The same 20% increase in 2007 might have been on a $400/mo policy, so it added $80. A 25% increase in co-pay from $40 to $50 is barely noticeable, unless you're old enough to remember when insurance didn't have co-pays. (As an aside, that pre-ACA policy might not have covered actually getting sick or needing medical care.) This compounding had been going on since at least the 1980s, and it was inevitable that it would get large enough to notice at some point. Anecdotally, the policies on offer here (GA) on the individual market are markedly less expensive than the trend line circa 2007 would have predicted for 2019. And they cover more, since the fake insurance has been outlawed. Curious what others have noticed, but this has been my experience.
  - skohan 7y ago
    The ACA was probably literally life-saving for a lot of people in my cohort, who were maximally affected by the 2008 crisis and could stay on their parents' insurance plan after graduating university and before finding full-time employment. The same goes for people who were uninsurable due to pre-existing conditions. It might have been inconvenient for you if your policy rates went up, but the system was not working before the ACA. It's still not great, but at least less people are shut out of the system completely.
- skohan 7y ago
  > And that solution is unlikely to have much impact on costs. How do you reach that conclusion? National health insurers almost always pay less item-for-item than private plans, because they represent a large proportion of income for healthcare providers and thus have immense bargaining power. Medicare, for example, pays less for medications and procedures than almost anyone else. There's no reason to believe they wouldn't get an even better deal if more of the population was under their coverage.

by Frondo 7y ago

rayiner 7y ago

When people are polled about “private insurance” I don’t think they’re thinking about private insurance for elective procedures. I think the point shows that the large majority of people want, at most, a public option as an alternative to their existing private insurance. And that solution is unlikely to have much impact on costs. At the end of the day, the thing that came out of the political process (ACA plus Medicaid expansion) is probably the closest thing that has been proposed to what people are actually comfortable with.

jcadam 7y ago
I'm certainly not comfortable with the ACA. I'm old enough to remember what health insurance was like before Obama came along. The sudden and dramatic increase in premiums, deductibles, and co-insurance was effectively a massive pay cut for the entire American middle class. The government took a bad situation (the US healthcare system) and managed to make it a lot worse.
- Frondo 7y ago
  Yes and no. Eliminating the pre-existing conditions restrictions was life-changing for me and a lot of people I know; I'd had a surgery in 2005 that, up to whenever Obamacare was passed, excluded me from buying any health insurance from a private insurer. They all declined me as having had a pre-existing condition (having been operated on). Obamacare taking that away? A good thing. The medicaid expansion was significant for several of my friends, too. Suddenly, they qualified for medicaid! Again, big improvement in their quality of life. Lots wrong with the ACA, and for my part I wish we'd had the public option, but overall I don't think it made health care worse; just changed the good and bad to affect different people.
- runako 7y ago
  I've been buying insurance on the individual & small-group markets for almost 20 years. I've done this across three states. Which is to say I am keenly aware of how much healthcare has cost in both the pre-ACA and post-ACA timeframes. > The sudden and dramatic increase in premiums, deductibles, and co-insurance was effectively a massive pay cut for the entire American middle class. This is just a misrepresentation (or overgeneralization) of facts. One thing that was true before the ACA is that insurance rates increased monotonically every year, often by large percentages. This also applies to deductibles and co-insurance. What changed was compounding. In 2002, a 20% increase on a $150/mo policy added $30 to the price. The same 20% increase in 2007 might have been on a $400/mo policy, so it added $80. A 25% increase in co-pay from $40 to $50 is barely noticeable, unless you're old enough to remember when insurance didn't have co-pays. (As an aside, that pre-ACA policy might not have covered actually getting sick or needing medical care.) This compounding had been going on since at least the 1980s, and it was inevitable that it would get large enough to notice at some point. Anecdotally, the policies on offer here (GA) on the individual market are markedly less expensive than the trend line circa 2007 would have predicted for 2019. And they cover more, since the fake insurance has been outlawed. Curious what others have noticed, but this has been my experience.
- skohan 7y ago
  The ACA was probably literally life-saving for a lot of people in my cohort, who were maximally affected by the 2008 crisis and could stay on their parents' insurance plan after graduating university and before finding full-time employment. The same goes for people who were uninsurable due to pre-existing conditions. It might have been inconvenient for you if your policy rates went up, but the system was not working before the ACA. It's still not great, but at least less people are shut out of the system completely.
skohan 7y ago
> And that solution is unlikely to have much impact on costs. How do you reach that conclusion? National health insurers almost always pay less item-for-item than private plans, because they represent a large proportion of income for healthcare providers and thus have immense bargaining power. Medicare, for example, pays less for medications and procedures than almost anyone else. There's no reason to believe they wouldn't get an even better deal if more of the population was under their coverage.