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Win column: ending “preexisting condition” horror, and prices supposedly have not gone up as much as they were expected to otherwise. Marketplace plans are rela

Win column: ending “preexisting condition” horror, and prices supposedly have not gone up as much as they were expected to otherwise. Marketplace plans are relatively easy to compare, which is welcome. Loss column: Insurance rate increases still bonkers and unsustainable (IOW at some point, it’ll get high enough to force some kind of big shift or reform, with a lot of suffering and economic damage along the way). No public option. Not all plans are on the exchange (this varies state by state). Even “gold” plans are kinda shit and insurance still tends to cover less each year, even as prices increase. Fewer insurers offering individual plans at all, at least in some states. Healthcare spending in general still stupid-high and getting higher. Whole thing’s still very complicated, adding costs all over the economy and putting a significant time-burden on sick people and families of sick people, all for no reason whatsoever except protecting a bunch (a whole bunch) of middlemen’s jobs.

js2 3y ago
Joe Lieberman is the reason for the lack of a public option. https://publicintegrity.org/health/elimination-of-public-option-threw-consumers-to-the-insurance-wolves/ https://publicintegrity.org/health/elimination-of-public-opt... https://slate.com/news-and-politics/2009/10/did-sen-joe-lieberman-just-kill-the-public-option.html https://slate.com/news-and-politics/2009/10/did-sen-joe-lieb...
- kaibee 3y ago
  This is unfair to all of the Republicans who refused to vote for the plan too.
jandrewrogers 3y ago
The ACA increased costs far beyond what they otherwise would have been. It made the cost of good health insurance go up 25% overnight where I lived. The discontinuity in price increases before and after ACA were pretty stark, and not in a good way.
- tzs 3y ago
  Any mine went down. There are some charts of health insurance costs over time [1] here. These charts look the same pre-ACA and post-ACA. Costs continued to rise at about the same rate has they had before. [1] https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/ https://www.kff.org/report-section/ehbs-2023-section-1-cost-...
- wolverine876 3y ago
  Why do you think it was ACA? Health insurance costs have been increasing rapidly for decades.
deltarholamda 3y ago
This maps with my experience. I have one child with pre-ACA and one child with post-ACA non-marketplace plans. The post-ACA is expensive and not good, the pre-ACA is okay, but essentially neck and neck with the post-ACA on price. The pre-existing condition coverage part is really important for us. The problem with all health insurance is the opacity of actual costs. 80/20, deductible, out-of-pocket, these things are not trivial and they wander all over the place. Add to that the seemingly random prices charged by healthcare providers, which are even less understandable as "adjustments" are made. Nobody has any idea what anything costs. Healthcare providers throw out a number, see how much they get back, and call that the price. It's absolutely insane. The only way you can get this level of brokenness is to combine government, big corporations, and a powerful middleman lobby and let them figure out how to run things. All this nonsense to avoid "socialized medicine."
tzs 3y ago
> Loss column: Insurance rate increases still bonkers and unsustainable. [...] Healthcare spending in general still stupid-high and getting higher. Worse, nobody seems to have any idea how to fix that. For the problem of high costs we can at least take a look at what other first world countries do for some idea. Most are spending well under 1/2 of what we spend. For the problem of increasing costs though we can't look at others because they too have increasing costs comparable to the rate of increase of US costs. For example, in 1980 the per capita health costs in the UK, France, and the US were (in USD) 385, 659, and 1036. And here is what the costs were in those countries in 1990, 2000, 2010, and 2018, divided by that country's 1980 costs: Year UK FR US 1990 2.0 2.2 2.6 2000 4.1 4.1 4.4 2010 7.5 6.1 7.7 2018 10.6 7.5 10.2 Here are a few countries and the ratio of their 2018 to 2000 costs: 2.1 Germany 1.8 France 2.0 Canada 1.7 Italy 2.6 Japan 2.6 UK 2.3 US I used 2018 instead of 2020 because I did this calculation a few years ago, and 2018 was the latest data at the time. My source now has data through 2022. If anyone wants to do this for other years, or for other countries, here's how to get the data: 1. Go to https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm 2. Uncheck "latest data available". This enables the year range selector control. 3. Use the year range selector to expand the range to cover the years you are interested in. They have 1970-2022. 4. The chart will then show the total costs in US dollars/capita by year of health care in 50 countries. You can use the "Highlighted Countries" drop down to narrow that to select a "background" of OECD, EU, Euro Area, G7, or G20 if you want. You can then add individual countries using the list on the left of that dialog. 5. You can change what is shown from total to government/compulsory, voluntary, or out-of-pocket and you can change the measure from per capita to % of GDP.
BeFlatXIII 3y ago
IMO, the #1 failure of Obamacare exchange markets is that employer-sponsored group plans remained legal under the ACA. Everyone should have been forced into the same free market.

js2 3y ago

Joe Lieberman is the reason for the lack of a public option. https://publicintegrity.org/health/elimination-of-public-option-threw-consumers-to-the-insurance-wolves/ https://publicintegrity.org/health/elimination-of-public-opt... https://slate.com/news-and-politics/2009/10/did-sen-joe-lieberman-just-kill-the-public-option.html https://slate.com/news-and-politics/2009/10/did-sen-joe-lieb...

kaibee 3y ago
This is unfair to all of the Republicans who refused to vote for the plan too.

jandrewrogers 3y ago

The ACA increased costs far beyond what they otherwise would have been. It made the cost of good health insurance go up 25% overnight where I lived. The discontinuity in price increases before and after ACA were pretty stark, and not in a good way.

tzs 3y ago
Any mine went down. There are some charts of health insurance costs over time [1] here. These charts look the same pre-ACA and post-ACA. Costs continued to rise at about the same rate has they had before. [1] https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/ https://www.kff.org/report-section/ehbs-2023-section-1-cost-...
wolverine876 3y ago
Why do you think it was ACA? Health insurance costs have been increasing rapidly for decades.

deltarholamda 3y ago

This maps with my experience. I have one child with pre-ACA and one child with post-ACA non-marketplace plans. The post-ACA is expensive and not good, the pre-ACA is okay, but essentially neck and neck with the post-ACA on price. The pre-existing condition coverage part is really important for us. The problem with all health insurance is the opacity of actual costs. 80/20, deductible, out-of-pocket, these things are not trivial and they wander all over the place. Add to that the seemingly random prices charged by healthcare providers, which are even less understandable as "adjustments" are made. Nobody has any idea what anything costs. Healthcare providers throw out a number, see how much they get back, and call that the price. It's absolutely insane. The only way you can get this level of brokenness is to combine government, big corporations, and a powerful middleman lobby and let them figure out how to run things. All this nonsense to avoid "socialized medicine."

tzs 3y ago

> Loss column: Insurance rate increases still bonkers and unsustainable. [...] Healthcare spending in general still stupid-high and getting higher. Worse, nobody seems to have any idea how to fix that. For the problem of high costs we can at least take a look at what other first world countries do for some idea. Most are spending well under 1/2 of what we spend. For the problem of increasing costs though we can't look at others because they too have increasing costs comparable to the rate of increase of US costs. For example, in 1980 the per capita health costs in the UK, France, and the US were (in USD) 385, 659, and 1036. And here is what the costs were in those countries in 1990, 2000, 2010, and 2018, divided by that country's 1980 costs: Year UK FR US 1990 2.0 2.2 2.6 2000 4.1 4.1 4.4 2010 7.5 6.1 7.7 2018 10.6 7.5 10.2 Here are a few countries and the ratio of their 2018 to 2000 costs: 2.1 Germany 1.8 France 2.0 Canada 1.7 Italy 2.6 Japan 2.6 UK 2.3 US I used 2018 instead of 2020 because I did this calculation a few years ago, and 2018 was the latest data at the time. My source now has data through 2022. If anyone wants to do this for other years, or for other countries, here's how to get the data: 1. Go to https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm 2. Uncheck "latest data available". This enables the year range selector control. 3. Use the year range selector to expand the range to cover the years you are interested in. They have 1970-2022. 4. The chart will then show the total costs in US dollars/capita by year of health care in 50 countries. You can use the "Highlighted Countries" drop down to narrow that to select a "background" of OECD, EU, Euro Area, G7, or G20 if you want. You can then add individual countries using the list on the left of that dialog. 5. You can change what is shown from total to government/compulsory, voluntary, or out-of-pocket and you can change the measure from per capita to % of GDP.

BeFlatXIII 3y ago

IMO, the #1 failure of Obamacare exchange markets is that employer-sponsored group plans remained legal under the ACA. Everyone should have been forced into the same free market.