4 ms·

> That is fucking crazy. That sounds like a Blade-Runner-esque dystopia. And it’s our reality. From everything I read, it's rather scary to be poor in America,

> That is fucking crazy. That sounds like a Blade-Runner-esque dystopia. And it’s our reality. From everything I read, it's rather scary to be poor in America, especially if you have to deal with the judicial or medical system.

ars 6y ago
> or medical system. Poor people get medicaid, which is actually pretty decent insurance since it's private (non government) insurance, paid for by the government. It's actually the middle class that has it hard: Too rich for medicaid, too poor to easily afford the deductibles. (I know this is an unpopular opinion, but things were better before Obamacare - deductibles were much much lower.)
- ComputerGuru 6y ago
  Not just deductibles, my self-insured premiums have almost tripled since ACA.
- ithkuil 6y ago
  (non american here) so what was the problem ACA was designed to solve? I assume there must have been another group of people who are not poor enough but not middle class enough? Or something else? I care about your unpopular opinion since the popular ones are easier to find
  - dragonwriter 6y ago
    The ACA addressed numerous issues, some of the more notable ones: (1) it included a very significant expansion of Medicaid eligibility. (2) for people just outside of Medicaid eligibility, it includes public subsidies for exchange-listed plans. (3) it banned a number of practices which made insurance either inaccessible or illusory, most notably preexisting condition exclusions (and the associated practice of looking for an indicator of preexisting condition and using it as pretext to cancel the policy when someone was diagnosed with an expensive-to-care-for condition), but also cancel-and-refund practices, and lifetime benefit limits.
    - vkou 6y ago
      It should also be noted that all efforts to repeal the ACA don't come with anything to deal with problem #3.
- dragonwriter 6y ago
  > Poor people get medicaid, which is actually pretty decent insurance since it's private (non government) insurance, paid for by the government. Medicaid isn't consistently private insurance paid for by the government; though “managed risk” through outside (sometimes still publicly operated; several of them in California are county-run) plans is an increasingly popular model, though many states continue to have traditional fee-for-service model as well (California has a mix of managed care and fee-for-service.) > (I know this is an unpopular opinion, but things were better before Obamacare - deductibles were much much lower.) It's not the most popular opinion, by it remains extremely widespread, and lots of money, effort, and propaganda has expended to generate and maintain this opinion over the last decade. Also, premiums and deductibles were often lower because the combination of lifetime limits, preexisting condition exclusions and the associated recission practice [0], and the cancel-and-refund practice [1], all of which the ACA banned, made it possible for insurance companies to collect premiums and then find an excuse to leave people who thought they were insured uninsured when they actually needed the insurance most. [0] whereby insurance companies would investigate for anything they could characterize as evidence of an undisclosed preexistinf condition as a pretext for cancelling the policy once someone started to look like an expensive case. [1] whereby, lacking even the pretext of an undisclosed preexisting condition, when someone looked to become too expensive, the insurance company would just cancel their policy and refund all past premiums (and eat the cost of any previous benefits received.)
  - ars 6y ago
    > and lots of money, effort, and propaganda has expended I don't know anything about propaganda, I just know that my insurance got way way way worse after ACA. If you think every such report is propaganda you are not being honest with yourself.
    - dragonwriter 6y ago
      > I don't know anything about propaganda, I just know that my insurance got way way way worse after ACA. I suspect you know it got more expensive for the benefits from the perspective of someone not first starting to need it for something in the high tail of cost. The likelihood that you would get thrown off of your insurance in that case without effective remedy is something you probably haven't directly experienced, but it's a pretty significant factor in the quality of insurance, and is a very major cost drivers in the change from pre-ACA policy to the ACA.
- cmurf 6y ago
  Deductibles have been going up since the invention of HMO's. The idea the rate of increase had increased under PPACA is nonsense. If you want to complain about PPACA, complain about it expanding a greedy for-profit pay per procedure and pillpopping regime that pretends to be a a product. That system should be destroyed. Is immoral and has low efficacy compared to all other industrialized and civilized alternatives, whether public, or hybrid.

ars 6y ago

> or medical system. Poor people get medicaid, which is actually pretty decent insurance since it's private (non government) insurance, paid for by the government. It's actually the middle class that has it hard: Too rich for medicaid, too poor to easily afford the deductibles. (I know this is an unpopular opinion, but things were better before Obamacare - deductibles were much much lower.)

ComputerGuru 6y ago
Not just deductibles, my self-insured premiums have almost tripled since ACA.
ithkuil 6y ago
(non american here) so what was the problem ACA was designed to solve? I assume there must have been another group of people who are not poor enough but not middle class enough? Or something else? I care about your unpopular opinion since the popular ones are easier to find
- dragonwriter 6y ago
  The ACA addressed numerous issues, some of the more notable ones: (1) it included a very significant expansion of Medicaid eligibility. (2) for people just outside of Medicaid eligibility, it includes public subsidies for exchange-listed plans. (3) it banned a number of practices which made insurance either inaccessible or illusory, most notably preexisting condition exclusions (and the associated practice of looking for an indicator of preexisting condition and using it as pretext to cancel the policy when someone was diagnosed with an expensive-to-care-for condition), but also cancel-and-refund practices, and lifetime benefit limits.
  - vkou 6y ago
    It should also be noted that all efforts to repeal the ACA don't come with anything to deal with problem #3.
dragonwriter 6y ago
> Poor people get medicaid, which is actually pretty decent insurance since it's private (non government) insurance, paid for by the government. Medicaid isn't consistently private insurance paid for by the government; though “managed risk” through outside (sometimes still publicly operated; several of them in California are county-run) plans is an increasingly popular model, though many states continue to have traditional fee-for-service model as well (California has a mix of managed care and fee-for-service.) > (I know this is an unpopular opinion, but things were better before Obamacare - deductibles were much much lower.) It's not the most popular opinion, by it remains extremely widespread, and lots of money, effort, and propaganda has expended to generate and maintain this opinion over the last decade. Also, premiums and deductibles were often lower because the combination of lifetime limits, preexisting condition exclusions and the associated recission practice [0], and the cancel-and-refund practice [1], all of which the ACA banned, made it possible for insurance companies to collect premiums and then find an excuse to leave people who thought they were insured uninsured when they actually needed the insurance most. [0] whereby insurance companies would investigate for anything they could characterize as evidence of an undisclosed preexistinf condition as a pretext for cancelling the policy once someone started to look like an expensive case. [1] whereby, lacking even the pretext of an undisclosed preexisting condition, when someone looked to become too expensive, the insurance company would just cancel their policy and refund all past premiums (and eat the cost of any previous benefits received.)
- ars 6y ago
  > and lots of money, effort, and propaganda has expended I don't know anything about propaganda, I just know that my insurance got way way way worse after ACA. If you think every such report is propaganda you are not being honest with yourself.
  - dragonwriter 6y ago
    > I don't know anything about propaganda, I just know that my insurance got way way way worse after ACA. I suspect you know it got more expensive for the benefits from the perspective of someone not first starting to need it for something in the high tail of cost. The likelihood that you would get thrown off of your insurance in that case without effective remedy is something you probably haven't directly experienced, but it's a pretty significant factor in the quality of insurance, and is a very major cost drivers in the change from pre-ACA policy to the ACA.
cmurf 6y ago
Deductibles have been going up since the invention of HMO's. The idea the rate of increase had increased under PPACA is nonsense. If you want to complain about PPACA, complain about it expanding a greedy for-profit pay per procedure and pillpopping regime that pretends to be a a product. That system should be destroyed. Is immoral and has low efficacy compared to all other industrialized and civilized alternatives, whether public, or hybrid.