6 ms·
This is a real concern for me because people credit the ACA with making a big dent in the healthcare problem here in the US, but it feels more like it just crea
by thisisnotauser 2y ago
This is a real concern for me because people credit the ACA with making a big dent in the healthcare problem here in the US, but it feels more like it just created a massive legal protection for these exploitative middlemen when the necessary solution was to blow up the entire industry with a true public option that could out-compete every profit-driven money-extraction system by simply not being profit-driven.
Not every system becomes more efficient with profit incentives, and this really seems like just such a case.
- epistasis 2y agoThe ACA was the best compromise that could be struck at the time, with a large portion of the population being dead set against better healthcare if it meant allowing Obama to be able to take credit for it. This is the dirty part of the political process: people sacrifice better outcomes for all, merely for the pursuit of more power in the future. And those who want better outcomes for all must somehow gather a coalition that can achieve those outcomes. Nobody, least of all the architects of the ACA, thought it was the best possible system. It was merely the best system that could get through the democratic process of our government. Which means we need iterative design on these programs. It's not pass once and done forever. We need maintenance legislation for bug fixes and feature improvements. However, every culture war battle that we fight can be used to distract from actual reform, like a nefarious form of bike-shedding.
- fumeux_fume 2y agoAs silly as agile government sounds, if it forces our legislators to take part in the misery of a daily standup, I'm all for it.
- epistasis 2y agoLegislation is literally the code of society.
- JumpCrisscross 2y agoSort of. It’s more akin to design guidelines.
- epistasis 2y agoBy "literally" I mean that the name for it is the Code of Law, with a civil code, and a criminal code. And this usage of "code" predates computer programming by many centuries!
- joquarky 2y agoSo let's put it in a code versioning system.
- toast0 2y agoI wish we'd just say ok, people like Medicare, let's drop the age of enrollment by 1 year every year for ten years and see how that goes. If that works out, drop the age of enrollment by 2 years every year for the next ten years. Then figure it out from there. Could start as a paid option rather than just lowering the age when you get coverage based on work history, too. Maybe something for children too, start with making Medicaid or something automatic for the first N months of life, and increase it every year too.
- soks86 2y agoWe'd still be waiting for healthcare with this kind of plan. Before the ACA it simply was not a choice to be an independent professional and have health insurance. If people could understand why it is unacceptable to force independent professionals and entrepreneurs to give up healthcare they would see the ACA was necessary in whatever form it could be passed.
- deleted 2y ago[deleted]
- franktankbank 2y agoYou don't need to have insurance for the vast majority of care, yet it gets used as such. Let's drop that nonsense, it tangles up the billing process.
- mistrial9 2y agowhen you fall from a bicycle in traffic and need more than ten stitches, you probably want clean conditions and high skill people ready. Ordinary daily care is done by ordinary daily care people because there is so much of it to do. It is fairly rare to need ten stitches from a bicycle accident. This is an example of people in ordinary good health. When you get to chronic care and elder care, things change again. this call for "less reliance on insurance" lacks context and is overly-simplistic IMHO
- 2y ago
- gatlin 2y ago> with a large portion of the population being dead set against better healthcare if it meant allowing Obama to be able to take credit for it. This is a fiction people repeat with no citation. A large portion of the population wants m4a when it is explained to them. This "system" failure was specifically our elected reps - bipartisanly - ignoring the needs and wants of the people at the behest of their donors. The democratic process failure was when the two parties solidified. It wasn't pitchfork wielding illiterate rubes (or whatever undoubtedly out of touch "data driven" parody of what an average person is we're operating with) trying to deny a Black man his legacy, it was that Black man's party collectively wanting to be reelected that gave us the "Buy Insurance Or We Fine You Through Taxes" Act.
- jtmarl1n 2y agoYou say the comment you replied to cited no sources while making an assertion you disagree with. Then, you go on to do the very same thing.
- jordanb 2y ago> The ACA was the best compromise that could be struck at the time, That's not he way the ACA went down. Obama had this idea that the best way to reform an industry was to have it write its own reform legislation and pretty much let the industry have first draft. > with a large portion of the population being dead set against better healthcare if it meant allowing Obama to be able to take credit for it. The ACA was initially popular but it became increasingly unpopular during the months of horse trading, the explosion in length of the law, the jettisoning of most of the good parts (drug price controls, public option, etc), retention and expansion of industry giveaways (tax penalties), and yes, relentless Republican opposition and propaganda against it. But even the latter was Obama's fault for not being prepared to anticipate and deal. He actually spend the first several months pushing for a "bipartisan" deal with Republicans that gave them room to delay and attack. > with a large portion of the population being dead set against better healthcare if it meant allowing Obama to be able to take credit for it. Obama had a filibuster-proof supermajority in congress. Yes, Republicans were going to oppose his agenda, but he didn't need them. For some dumb reason he loaded a gun, pointed it at himself and handed it to them. There were lots of comparisons to Medicare/Medicaid being made at the time. That law was a fraction the size of ACA, the implementation phase was like a year instead of a decade for the ACA, and its effect on the public was immediate and profound. The failure of the Obama administration was the failure of technocracy. Obama thought he could have "experts" develop the ultimate "win-win" policy. What you ended up instead was a bunch of naked self-dealing by craven opportunists who either worked for the industries they were regulating or intended to do so in the future. People saw through this and it lead directly the the rise of Trump
- Webstir 2y agoLove how people try to rationalize these vultures. The elite and their PMC toadies are just corrupt. That’s it. The united states is corrupt to it’s core because we allowed the elite to run things.
- JumpCrisscross 2y ago> because we allowed the elite to run things By definition, a society’s elites always run things…
- forgetfreeman 2y agoTrue. How's that worked out so far?
- JumpCrisscross 2y ago> How's that worked out so far? Pretty damn well in the long run!
- voakbasda 2y agoWorked great for the French too, right up to the Revolution.
- JumpCrisscross 2y ago> Worked great for the French too, right up to the Revolution Each of the French Revolution’s successive governments had their own sets of elites. (La Révolution itself had its elites.) Arguing against elites as a category is arguing against hierarchical sociology. It’s inchoate. We don’t have an example of a society without elites; we barely have examples of social animals without hierarchies. (Zebra herds.) And speaking of the French Revolution, the elites ex post facto were not only mostly the same as before, they escaped with so much money and wealth that it’s actually debated if they increased their wealth share through the chaos [1]. [1] https://www.jstor.org/stable/650023 https://www.jstor.org/stable/650023
- renewiltord 2y agoPublic option would lead to pure fraud like in the ABMT treatment for breast cancer. Asking for trouble. Especially in the US where people believe that no one should trade grandma for a dollar. In the UK, they fortunately have a notion of money spent for QALYs earned (adjusted to boost life extension at end of life) but in the US everyone believes that we should spend arbitrary amounts of money on people and if we don't, we should pay their relatives extraordinary amounts to compensate for the fact that we didn't spend a few aircraft carriers worth of money on them. Put simply, so long as US ethics remains "there is no sum of money that is too high to save an arbitrary person's life", we have to oppose the public option.
- krapht 2y agoI'd like to see proof that Medicare does not evaluate QALY and spends unlimited money in general.
- renewiltord 2y agoThe percentage of the federal budget that is spent on dialysis and the life of the patient preceding when they're put on dialysis. Even without that, when Cuomo in NY said he wouldn't trade grandma for a dollar, there was thunderous applause across the US. And many here argued that the economy isn't as important as any life lost. That's enough to cement it for me.
- SoftTalker 2y agoAs if a "public option" would not have a middle tier that evaluated, and then approved or denied claims?
- Auracle 2y agoThat doesn’t matter when it’s subsidized by the government. When people talk for a public option all they’re really talking about is one option, because no company would be able to compete.
- ljf 2y agoWe have free at point of need healthcare here in the UK, and still have a lot of choice in private healthcare if you want it. In the nearest city to me there are 3 major private hospitals, and if you head into London there are loads of them. Private is still able to compete and to be profitable. Just no one needs to die from preventable diseases. (not saying NHS is perfect, it is a shadow of what it should be right now)
- ajb 2y agoSort of. My understanding is that private hospitals largely opt out of most of the difficult stuff, because the NHS is there to take it on. So they're good if you're waiting around for a hip replacement but not so much for other things.
- tialaramex 2y agoRight, essentially every private hospital's response if, say, a patient they're giving a boob job suddenly becomes unresponsive is to... call the NHS. Yeah, the medical staff will be better than your neighbour or some random passing guy in the street when it comes to knowing how to put you in recovery position or attempt CPR but those hospitals won't have a crash protocol beyond too bad call the NHS. I spent eight hours at an Accident & Emergency department at my city's hospital a couple of weeks ago (Those electric scooters look easy enough, I have a driving license, I watch the training video, then at midnight I thought I'd try one, signed it out, crashed into a lamp post within seconds, broke my hand and busted my head open. Oops. Signed the scooter back in, walked to the Urgent Care, it shuts late at night, walked towards hospital, saw a cop - "Hey, I can't see my head, I can feel the wound, is it bad?" "You should get a taxi to A&E. I'll call you one"). There is no private emergency care, private cosmetic surgery sure, and lots of private non-urgent care, like knee replacement or whatever - but no emergency care.
- roenxi 2y agoTypical US profit margins are somewhere in the area of 8%. If dropping healthcare costs by 8% is what people are arguing over then I've been badly mislead about the problems with the US healthcare system. There is a real issue with regulatory capture. Making the system purely public is not going to result in the regulators suddenly purging their souls of all corruption. It'll still be a disaster just without any pretence of an alternative. There are literally people on HN every day who would happily improve on the US healthcare system's costs and outcomes if well meaning busybodies hadn't banned them from doing so by overregulating.
- ForTheKidz 2y ago> There are literally people on HN every day who would happily improve on the US healthcare system's costs and outcomes if well meaning busybodies hadn't banned them from doing so by overregulating. I trust the market to provide healthcare about as much as I expect america to suddenly blast off to join the moon. And i trust vc/finance a hell of a lot less than that.
- roenxi 2y agoDo you feel the Trump & Musk dynamic duo are going to do a better job of handling it? They're cut from similar cloth.
- ForTheKidz 2y agoNo, of course not, this is just more extreme of the same behavior.
- rqtwteye 2y agoThe profit margins are not the only thing. There are tens or hundreds of thousands of people working on billing jobs at doctors and insurances that shouldn’t exist.
- Auracle 2y agoAnd you think a government run system would be more efficient? It’s still going to have people in each side verifying claims, preauthorizing stuff, etc. To do otherwise invites massive fraud.
- throwawayqqq11 2y ago> a true public option that could out-compete every profit-driven money-extraction system by simply not being profit-driven. Much like amazon did in the early days. When the problem is incentive structures -- of profit seeking corporations or compensation seeking individuals -- what options do you have? (IMO its only regulatory enforcement with democratic oversight and transparenct.) I think we as a society still have to figure out ways to restructure sprawling institutions and i dont like it when people only put the blame on public or private ones while ignoring the other.
- JumpCrisscross 2y ago> a true public option that could out-compete every profit-driven money-extraction system by simply not being profit-driven We can solve pharmaceuticals without bringing in the miasma of the broader healthcare debate. Three things: 1. Let Medicare directly negotiate pricing on all drugs; 2. Make it easier for generics producers, including foreign manufacturers, to sell into America; and 3. Reform PBMs [1]. Transparency on pricing. Spun out of monoliths. While we’re at it, maybe someone can figure out how to cut the $1bn it costs to get a drug to approval to something lower. [1] https://www.congress.gov/bill/118th-congress/senate-bill/2973/text https://www.congress.gov/bill/118th-congress/senate-bill/297...
- jjav 2y ago> This is a real concern for me because people credit the ACA with making a big dent in the healthcare problem here in the US, but it feels more like it just created a massive legal protection... Both are true! The ACA is a literal life-saver and bankrupcy-avoider for a significant percentage of the population. So it is a huge win for the common person. At the same time, yes, it perpetuates the corrupt insurance system, which is bad. But at least makes it more widely available, which is good. > Not every system becomes more efficient with profit incentives, and this really seems like just such a case. Health care can only ever get worse with profit incentives. The best way would be to eject all the profiteering out of the system so that only the people who provide actual care (doctors, nurses, medical technicians,etc) get paid. Remove all profit from the hangers-on that do nothing useful (insurance middlemen). The path to get there is obvious, but politically quite impossible in the US (and only in the US, since every other country has it figured out.)
- conductr 2y agoNothing in this article was a byproduct of ACA and it all predated it. But also in no way did it reduce costs, that’s a lie. Who even says that? Unless you’re only considering very specific benefits like birth control. Overall it increased costs, even when Medicare of any government program announces a reduction or sequestration the industry just raises prices everywhere else to offset. I’ve been in those decisions when I worked in the industry. We never let it flow through to bottom line, we always found a way.
- DarkNova6 2y agoProfit-chasing never makes systems more efficient. It’s competition.
- jacksnipe 2y agoIt made a massive difference in the day to day lives of the most affected people — the chronically ill. I cannot emphasize enough how much of a death sentence being chronically ill before the ACA was. No protection for preexisting conditions meant one unfortunate incident could cost you your job could cost your your healthcare could cost you your ability to get back on solid footing to get another job.
- Eddy_Viscosity2 2y agoThe middlemen would never allow a public option and they have enough money to stop it happening. US policy is the will of the rich not the people.
- neuralRiot 2y ago>Not every system becomes more efficient with profit incentives Maybe it does but not for the right people.