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The ACA was originally designed as a "three-legged stool" of nondiscrimination (insurance companies can't charge higher rates to sick people), the individual ma

The ACA was originally designed as a "three-legged stool" of nondiscrimination (insurance companies can't charge higher rates to sick people), the individual mandate, and subsidies. If you remove one of legs of the stool, the market becomes unstable and you see price spirals like this. Jonathan Gruber (MIT econ professor, and one of the designers of the Affordable Care Act) gave a fairly detailed talk about how and why they designed the ACA the way they did, learning from a similar law in Massachusetts: https://youtu.be/2fTHqARiV_Q?si=SRC6Np-rjgUgAe4Z&t=679 https://youtu.be/2fTHqARiV_Q?si=SRC6Np-rjgUgAe4Z&t=679

nothercastle 1y ago
In this case they removed 2. Subsidies and mandates
- tlogan 1y ago
  And they also added requirements what must be insured and maximum out of pocket. So you cannot have a cheap insurance with 20k max out of pocket.
  - senkora 1y ago
    You still can in some limited situations (like being under 30 years old) through “catastrophic” health plans.
mystraline 1y ago
Yep, the ACA was originally RomneyCare. Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls capitalist plan. Heritage foundation made this plan after Hillary Clinton pushed universal healthcare in 1994, as first lady. Howls of 'death panels' were heard all over republican talking points and radio shows. (The 'death panels' aka rationing was seen as bad for government to do. However, we see a new type of rationing, based upon how much patients cost, and then denying care. That lead to the UHC execution, then approving more procedures, then getting sued by shareholders for that. Personally, government death panels are preferred to capitalist death panels.) Put simply: Obama passed republican legislation put forth by a republican governor and a republican thinktank, and was deemed a socialist. And now, the program is basically destroyed.
- toomuchtodo 1y ago
  Bipartisanship is dead. If you want to win, play to win.
  - brookst 1y ago
    Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
    - toomuchtodo 1y ago
      I'm somewhat hopeful with Gavin Newsom's posture making an example, I wouldn't vote for him, but I like the aggressive PR position he's taken, his willingness to gerrymander just as the other side has been doing forever. That's what I mean by bipartisanship is dead. You can't negotiate with the other side, they do not want to negotiate, they want to win at all costs for ideology, so you can only do your best to disempower them. If you try to play fair with a counterparty who does not believe in acting in good faith or playing fair, you have default lost. You can't have a functional democracy when one side rejects democracy (massive efforts to disenfranchise voters, gerrymandering, etc) because they can't win democratically. There is no reason you can't have empathy while punching down at bullies, because if the tables were turned, the bullies would put their boot on your neck ("paradox of tolerance"). So, start punching down. Edit: In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves (considering how dependent red states are on the federal government [1] [2]); Oregon is up first [3]. You can increase state taxes to fund this, reducing tax dollars sent to the federal government, if properly engineered. [1]. https://time.com/7222411/blue-states-are-bailing-out-red-states/ https://time.com/7222411/blue-states-are-bailing-out-red-sta... [2] https://usafacts.org/articles/which-states-contribute-the-most-and-least-to-federal-revenue/ https://usafacts.org/articles/which-states-contribute-the-mo... [3] https://www.hcfawa.org/oregon_s_path_to_universal_health_carerecap https://www.hcfawa.org/oregon_s_path_to_universal_health_car...
      - ceejayoz 1y ago
getnormality 1y ago
My hope, perhaps naive, is that 95% of what happens in this Rube Goldberg machine basically amounts to the government paying private insurance companies to pay doctors, which is inefficient but ultimately straightforward.
- potato3732842 1y ago
  >which is inefficient but ultimately straightforward. That's an understatement on the order of saying WW2 was a rebalancing of geopolitical power. Healthcare is what? 20% of GPD. Likely half of that is paper pushing compliance checking rubber stamping that likely ought not to exist.
  - pjc50 1y ago
    Unfortunately there's a fraud problem, NOT by patients but by various entities claiming for unnecessary or never-performed procedures. https://pubmed.ncbi.nlm.nih.gov/25068880/ https://pubmed.ncbi.nlm.nih.gov/25068880/
  - getnormality 1y ago
    I was going to push back against this, but when I googled "what percent of American health care is administrative costs" I got back numbers ranging from 15-34%, which is pretty darn high. Much higher than the last number I heard, which was something like 8%. The factor of two variance is kind of disturbing in itself.
    - zdw 1y ago
      All this means is that for insurance companies to maximize their administrative costs they push up the overall price - from their perspective making 10% of $10M is way better than 10% of $5M.
      - potato3732842 1y ago
        Drives me up the wall that the same people who can correctly identify when nominal nonprofits like rich people's charity organizations universities or even hospitals are pissing away money on officer salaries, perks, facilities, etc. because "nonprofit" think that somehow being a 10% or X% profit capped organization can't do the same thing with whatever expenses they aren't capped on.

nothercastle 1y ago

In this case they removed 2. Subsidies and mandates

tlogan 1y ago
And they also added requirements what must be insured and maximum out of pocket. So you cannot have a cheap insurance with 20k max out of pocket.
- senkora 1y ago
  You still can in some limited situations (like being under 30 years old) through “catastrophic” health plans.

mystraline 1y ago

Yep, the ACA was originally RomneyCare. Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls capitalist plan. Heritage foundation made this plan after Hillary Clinton pushed universal healthcare in 1994, as first lady. Howls of 'death panels' were heard all over republican talking points and radio shows. (The 'death panels' aka rationing was seen as bad for government to do. However, we see a new type of rationing, based upon how much patients cost, and then denying care. That lead to the UHC execution, then approving more procedures, then getting sued by shareholders for that. Personally, government death panels are preferred to capitalist death panels.) Put simply: Obama passed republican legislation put forth by a republican governor and a republican thinktank, and was deemed a socialist. And now, the program is basically destroyed.

toomuchtodo 1y ago
Bipartisanship is dead. If you want to win, play to win.
- brookst 1y ago
  Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
  - toomuchtodo 1y ago
    I'm somewhat hopeful with Gavin Newsom's posture making an example, I wouldn't vote for him, but I like the aggressive PR position he's taken, his willingness to gerrymander just as the other side has been doing forever. That's what I mean by bipartisanship is dead. You can't negotiate with the other side, they do not want to negotiate, they want to win at all costs for ideology, so you can only do your best to disempower them. If you try to play fair with a counterparty who does not believe in acting in good faith or playing fair, you have default lost. You can't have a functional democracy when one side rejects democracy (massive efforts to disenfranchise voters, gerrymandering, etc) because they can't win democratically. There is no reason you can't have empathy while punching down at bullies, because if the tables were turned, the bullies would put their boot on your neck ("paradox of tolerance"). So, start punching down. Edit: In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves (considering how dependent red states are on the federal government [1] [2]); Oregon is up first [3]. You can increase state taxes to fund this, reducing tax dollars sent to the federal government, if properly engineered. [1]. https://time.com/7222411/blue-states-are-bailing-out-red-states/ https://time.com/7222411/blue-states-are-bailing-out-red-sta... [2] https://usafacts.org/articles/which-states-contribute-the-most-and-least-to-federal-revenue/ https://usafacts.org/articles/which-states-contribute-the-mo... [3] https://www.hcfawa.org/oregon_s_path_to_universal_health_carerecap https://www.hcfawa.org/oregon_s_path_to_universal_health_car...
    - ceejayoz 1y ago

getnormality 1y ago

My hope, perhaps naive, is that 95% of what happens in this Rube Goldberg machine basically amounts to the government paying private insurance companies to pay doctors, which is inefficient but ultimately straightforward.

potato3732842 1y ago
>which is inefficient but ultimately straightforward. That's an understatement on the order of saying WW2 was a rebalancing of geopolitical power. Healthcare is what? 20% of GPD. Likely half of that is paper pushing compliance checking rubber stamping that likely ought not to exist.
- pjc50 1y ago
  Unfortunately there's a fraud problem, NOT by patients but by various entities claiming for unnecessary or never-performed procedures. https://pubmed.ncbi.nlm.nih.gov/25068880/ https://pubmed.ncbi.nlm.nih.gov/25068880/
- getnormality 1y ago
  I was going to push back against this, but when I googled "what percent of American health care is administrative costs" I got back numbers ranging from 15-34%, which is pretty darn high. Much higher than the last number I heard, which was something like 8%. The factor of two variance is kind of disturbing in itself.
  - zdw 1y ago
    All this means is that for insurance companies to maximize their administrative costs they push up the overall price - from their perspective making 10% of $10M is way better than 10% of $5M.
    - potato3732842 1y ago
      Drives me up the wall that the same people who can correctly identify when nominal nonprofits like rich people's charity organizations universities or even hospitals are pissing away money on officer salaries, perks, facilities, etc. because "nonprofit" think that somehow being a 10% or X% profit capped organization can't do the same thing with whatever expenses they aren't capped on.