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No, losing ACA matters. It's a good program that's helping people afford or qualify for life insurance. I was able to get insurance because of it.

beedeebeedee 1y ago
Yes, but it does not provide health care, it provides a subsidy to the health insurance companies (I.e., throwing even more money at lucrative companies that profit by denying coverage). It is sad that it is the best our government can do for us.
- kelnos 1y ago
  It is sad, agreed, but having the ACA is better than not having it.
  - roenxi 1y ago
    That seems like a difficult one to provide evidence for. A major problem in the US seems to be that they've got this impenetrable thicket of legislation around healthcare, insurance and employment that makes it impossible for people to make rational decisions. Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA.
    - kelnos 1y ago
      > Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA. Maybe? But what is the mechanism by which employment gets decoupled from health insurance? That would require a different law, I suppose? But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws. I can think of quite a lot of alternative healthcare reform laws that would be significantly better than the ACA. And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins, if we judge by the millions of people who will lose healthcare coverage if the ACA were to be repealed and not replaced with anything new.
      - roenxi 1y ago
        > But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws. It seems to be the only way to interpret what you suggested. How could it end up in a situation where there aren't other alternative laws? There are automatically laws governing what people do - laws exist. The conversation is entirely about which laws are best. In this case, I'm arguing that generic rules (not specifically tailored to healthcare) are probably better, since a generic market seems to outperforms the US healthcare system. > And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins Well I can't control what you think but I can point out that it is a hard stance to provide evidence for. Healthcare is fundamentally less important than really urgent and essential services like food production or utilities and they manage to get great coverage with relatively limited fuss. The reports I've heard are that people find the situation in healthcare to be quite substandard.
    - threatofrain 1y ago
      I honestly don't understand why good healthcare should develop under free rational conditions. Why shouldn't a hospital charge your everything while you are in critical condition? I mean, it's a voluntary deal, take it or leave it, right?
      - actionfromafar 1y ago
        When people say “no regulations” they almost always mean “except these unspoken base rules I take for granted”. Unregulated market is an oxymoron. It’s always regulated by someone, warlords being the extreme devolution.
      - roenxi 1y ago
        You could ask the same question most things. Food and water for example - both more urgent and more necessary than most medical care. The costs are still low.
        threatofrain 1y ago
        For food and water, if you were caught in a tough place, I suppose I could charge you for everything. But most people aren't refugees in a hostile land, so they have the time to drive around. For a medical emergency it does make sense for a doctor to ask if you would like to voluntarily consider an interesting bargain.
        roenxi 1y ago
        The vast, vast majority of the spending in the healthcare industry is for things that you have time to drive around for. And I'd still rather have a private option in the event of a medical emergency. Ironically, insurance in a free market is actually really good at sorting out that sort of risk. The insurance company has strong incentives to negotiate what will happen in an emergency and it isn't that hard to make agreements with people in advance.
parineum 1y ago
I'm not really arguing against the ACA in particular, just the general sentiment. I do, however, think the passage and defense of the ACA has completely stopped any kind of healthcare reform movements from Democrats and completely turned Republicans against the idea.
- kelnos 1y ago
  The ACA was more or less the GOP's healthcare reform plan[0]. They fought so hard against it because they didn't want the Democrats to get credit for it. The ongoing animosity toward it from Republicans is ridiculous, and Democrats are even further from being able to pass any more healthcare reforms than they were when the ACA was passed. The all-too-brief excitement for Medicare For All is somewhat emblematic of that. [0] To be fair, it did go further than previous GOP proposals. They did include individual/employer mandates and a marketplace, but not stuff like the Medicaid expansion and higher taxes on high earners to help pay for it.
  - miley_cyrus 1y ago
    That's outrageously false: every Republican voted against ACA, and Republicans for years campaigned on trying to overturn it.
    - kelnos 1y ago
      That's... not arguing against anything I said? Maybe I wasn't clear. Let me try again. Many of the policies behind the ACA had long been championed by Republicans, or even originated in conservative circles. For example: 1. The individual mandate was something the Heritage Foundation (a conservative think tank) originally came up with back in the 80s, and was presented as an alternative to Clinton's healthcare plans in the 90s. 2. The state-based exchange system was something already present in some red states like Utah, and the concept is very similar to Republican proposals (again) back in the 90s. (This shouldn't be surprising: conservatives tend to prefer that states administer programs like these. Not a criticism; just noting a tendency.) 3. Much of the ACA's framework is similar to Republican Governor Mitt Romney's healthcare reform in Massachusetts from 2006. Sure, there are parts of the ACA that Republicans genuinely didn't support (e.g. Medicaid expansion, high-income-earner tax increases, requiring insurers to cover contraception). But big, fundamental parts of it were similar to or exactly like conservative healthcare reform plans that had been proposed over the past couple decades. The only reason I can see to explain why Republicans so vehemently fought and voted against the ACA (and have subsequently repeatedly tried -- and failed -- to repeal it) is because they didn't want Democrats to get credit for enacting it, and once it became "blue policy", it was automatically capital-B Bad to them. It's also telling that Republicans have failed so miserably at repealing it (though they have done it damage). That's because they have no alternative... because the ACA is more or less what they wanted in the first place.

beedeebeedee 1y ago

Yes, but it does not provide health care, it provides a subsidy to the health insurance companies (I.e., throwing even more money at lucrative companies that profit by denying coverage). It is sad that it is the best our government can do for us.

kelnos 1y ago
It is sad, agreed, but having the ACA is better than not having it.
- roenxi 1y ago
  That seems like a difficult one to provide evidence for. A major problem in the US seems to be that they've got this impenetrable thicket of legislation around healthcare, insurance and employment that makes it impossible for people to make rational decisions. Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA.
  - kelnos 1y ago
    > Just not having that legislation, letting employment & insurance decouple and a sane market for healthcare develop might easily be better than the ACA. Maybe? But what is the mechanism by which employment gets decoupled from health insurance? That would require a different law, I suppose? But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws. I can think of quite a lot of alternative healthcare reform laws that would be significantly better than the ACA. And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins, if we judge by the millions of people who will lose healthcare coverage if the ACA were to be repealed and not replaced with anything new.
    - roenxi 1y ago
      > But that wasn't what I suggested: I said having the ACA is better than not having it, not that having the ACA is better than other possible alternative laws. It seems to be the only way to interpret what you suggested. How could it end up in a situation where there aren't other alternative laws? There are automatically laws governing what people do - laws exist. The conversation is entirely about which laws are best. In this case, I'm arguing that generic rules (not specifically tailored to healthcare) are probably better, since a generic market seems to outperforms the US healthcare system. > And I think it's reasonably safe to say that in "ACA vs. nothing else", ACA wins Well I can't control what you think but I can point out that it is a hard stance to provide evidence for. Healthcare is fundamentally less important than really urgent and essential services like food production or utilities and they manage to get great coverage with relatively limited fuss. The reports I've heard are that people find the situation in healthcare to be quite substandard.
  - threatofrain 1y ago
    I honestly don't understand why good healthcare should develop under free rational conditions. Why shouldn't a hospital charge your everything while you are in critical condition? I mean, it's a voluntary deal, take it or leave it, right?
    - actionfromafar 1y ago
      When people say “no regulations” they almost always mean “except these unspoken base rules I take for granted”. Unregulated market is an oxymoron. It’s always regulated by someone, warlords being the extreme devolution.
    - roenxi 1y ago
      You could ask the same question most things. Food and water for example - both more urgent and more necessary than most medical care. The costs are still low.
      - threatofrain 1y ago
        For food and water, if you were caught in a tough place, I suppose I could charge you for everything. But most people aren't refugees in a hostile land, so they have the time to drive around. For a medical emergency it does make sense for a doctor to ask if you would like to voluntarily consider an interesting bargain.
        roenxi 1y ago
        The vast, vast majority of the spending in the healthcare industry is for things that you have time to drive around for. And I'd still rather have a private option in the event of a medical emergency. Ironically, insurance in a free market is actually really good at sorting out that sort of risk. The insurance company has strong incentives to negotiate what will happen in an emergency and it isn't that hard to make agreements with people in advance.

parineum 1y ago

I'm not really arguing against the ACA in particular, just the general sentiment. I do, however, think the passage and defense of the ACA has completely stopped any kind of healthcare reform movements from Democrats and completely turned Republicans against the idea.

kelnos 1y ago
The ACA was more or less the GOP's healthcare reform plan[0]. They fought so hard against it because they didn't want the Democrats to get credit for it. The ongoing animosity toward it from Republicans is ridiculous, and Democrats are even further from being able to pass any more healthcare reforms than they were when the ACA was passed. The all-too-brief excitement for Medicare For All is somewhat emblematic of that. [0] To be fair, it did go further than previous GOP proposals. They did include individual/employer mandates and a marketplace, but not stuff like the Medicaid expansion and higher taxes on high earners to help pay for it.
- miley_cyrus 1y ago
  That's outrageously false: every Republican voted against ACA, and Republicans for years campaigned on trying to overturn it.
  - kelnos 1y ago
    That's... not arguing against anything I said? Maybe I wasn't clear. Let me try again. Many of the policies behind the ACA had long been championed by Republicans, or even originated in conservative circles. For example: 1. The individual mandate was something the Heritage Foundation (a conservative think tank) originally came up with back in the 80s, and was presented as an alternative to Clinton's healthcare plans in the 90s. 2. The state-based exchange system was something already present in some red states like Utah, and the concept is very similar to Republican proposals (again) back in the 90s. (This shouldn't be surprising: conservatives tend to prefer that states administer programs like these. Not a criticism; just noting a tendency.) 3. Much of the ACA's framework is similar to Republican Governor Mitt Romney's healthcare reform in Massachusetts from 2006. Sure, there are parts of the ACA that Republicans genuinely didn't support (e.g. Medicaid expansion, high-income-earner tax increases, requiring insurers to cover contraception). But big, fundamental parts of it were similar to or exactly like conservative healthcare reform plans that had been proposed over the past couple decades. The only reason I can see to explain why Republicans so vehemently fought and voted against the ACA (and have subsequently repeatedly tried -- and failed -- to repeal it) is because they didn't want Democrats to get credit for enacting it, and once it became "blue policy", it was automatically capital-B Bad to them. It's also telling that Republicans have failed so miserably at repealing it (though they have done it damage). That's because they have no alternative... because the ACA is more or less what they wanted in the first place.