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The 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 al

The 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 ago
As 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 ago
  Legislation is literally the code of society.
  - JumpCrisscross 2y ago
    Sort of. It’s more akin to design guidelines.
    - epistasis 2y ago
      By "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!
      - 6510 2y ago
        is it safe?
        epistasis 2y ago
        Absolutely not. It regularly performs invalid rights on unallocated memory and even kills people.
        6510 2y ago
        does it map closely enough for an obvious replacement ...uhhh language?
  - joquarky 2y ago
    So let's put it in a code versioning system.
toast0 2y ago
I 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 ago
  We'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 ago
    You 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 ago
      when 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 ago
  You 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

fumeux_fume 2y ago

As 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 ago
Legislation is literally the code of society.
- JumpCrisscross 2y ago
  Sort of. It’s more akin to design guidelines.
  - epistasis 2y ago
    By "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!
    - 6510 2y ago
      is it safe?
      - epistasis 2y ago
        Absolutely not. It regularly performs invalid rights on unallocated memory and even kills people.
        6510 2y ago
        does it map closely enough for an obvious replacement ...uhhh language?
- joquarky 2y ago
  So let's put it in a code versioning system.

toast0 2y ago

I 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 ago
We'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 ago
  You 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 ago
    when 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 ago
You 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