5 ms·

I'll give you one reason, among many, it wasn't a failure. It made it illegal to deny people health insurance coverage based on pre existing conditions. That wa

I'll give you one reason, among many, it wasn't a failure. It made it illegal to deny people health insurance coverage based on pre existing conditions. That was a big step forward in a broken system to restore some humanity to the system.

dbg31415 1y ago
True (*) They can't deny coverage for pre-existing conditions anymore, but insurers still have hundreds of other ways to avoid paying. There's no silver lining in the U.S. healthcare system -- it's built to exhaust, confuse, and bankrupt patients. And it's only gotten worse in recent years. (Will only get worse with the addition of more AI.) Joe Lieberman, a supposed Democrat, killed any real chance for reform we had in our generation. He then left Congress and quickly died -- his legacy is the broken healthcare system we have today, totally rigged against the very patients it's supposed to serve.
- ZeroGravitas 1y ago
  Joe Lieberman and basically every Republican ever, for decades. And the Republicans on the Supreme Court that hobbled what the Democrats managed to narrowly get through the political process. But sure, direct all the anger for that towards Democrats, that will result in better Healthcare any day now. I hear Trump has concepts of a plan that he's been working on for over a decade that he'll let us know about in just 2 weeks.
  - johnnyanmac 1y ago
    I'm so tired of "this plan wasn't perfect, it failed. Democrats suck". And meanwhile the republican plan was to do nothing or actively make things worse than ignoring the problem. Why are some people seemingly hardwired to just blame democrats for any or everything? Because the plans they have don't immediately benefit them, the middle class person who was never down on their luck? Even then, I fail to think of any policy that legitmately benefits the middle class either. Did abortion bans improve your quality of life? Do immigration raids help your 401k? Did that cut to EV credits get you better public transit?
    - ZeroGravitas 1y ago
      Murc's Law https://en.wikipedia.org/wiki/Murc%27s_law https://en.wikipedia.org/wiki/Murc%27s_law > Murc’s Law is typically phrased as: "the widespread assumption that only Democrats have any agency or causal influence over American politics".[5] [6] It reflects a perceived journalistic double standard, where Democrats are held responsible for political outcomes regardless of context, whereas Republican obstruction or extremism is treated as a given. This framing, critics argue, absolves Republicans of responsibility and creates an unbalanced political narrative.
      - meowface 1y ago
        Like half this sub-thread is driving me insane. The deep hatred of Democrats (for decades) from the left is very frustrating to me. They may not be as left-wing as those people might like but they're in fact not nearly as bad as the Republicans.
      - nobody9999 1y ago
        >Murc's Law Which, somehow is a weird outcome of the "Two Santas Theory[0]. I'm not sure why folks actually buy into it, but they apparently do. [0] https://en.wikipedia.org/wiki/Jude_Wanniski#The_Two_Santa_Claus_Theory https://en.wikipedia.org/wiki/Jude_Wanniski#The_Two_Santa_Cl...
slg 1y ago
I'll throw in extending parental coverage to 26. I have a sibling with type 1 diabetes and it's impossible for me to describe the positive impact those two provisions have had on their life. Just because a piece of a legislation includes painful compromises doesn't mean we should ignore its huge wins.
- noir_lord 1y ago
  That has in part become the issue in modern politics, any compromise no matter how minor is seen as a loss. Neither sides most ardent supporters was willing to accept anything that looked like a compromise and so you end up with things as they are now, with someone where compromise shouldn’t happen because there is no practical compromise. US politics has collapsed down to the scorpion and the frog.
  - thunky 1y ago
    > That has in part become the issue in modern politics, any compromise no matter how minor is seen as a loss. Because to those who are now getting hit with huge insurance bills as a direct effect of that compromise, and may have to go without insurance at all, it is a loss. And nothing has been done to address the underlying reasons and bad incentives that have led to this outcome. Which is also a failure.
    - lotsofpulp 1y ago
      >Because to those who are now getting hit with huge insurance bills as a direct effect of that compromise, and may have to go without insurance at all, it is a loss. Because the Republicans slashed the premium tax credits to pay for tax cuts for rich people.
      - mothballed 1y ago
        The fact Republicans wouldn't repeal ACA but would repeal the tax credits just shows both sides prefer it to be broken. Democrats could shove through enough votes to repeal ACA to make health insurance cheaper for lower-risk groups without tax credits; Republicans could re-instate tax credits. Instead we are stuck in this bastardized half-socialized model that gets the worst of all worlds. Politics in the USA has basically gridlocked to it being much cheaper to shit on the other guy than to fix things. In two party system you can actually win by only making the other guy look worse, which only requires breaking things in a way that can be pointed at the other guy, somehow we are stuck in this local minima.
miley_cyrus 1y ago
No that is a huge failure. That is perhaps the biggest failure of Obamacare. That means I, as someone with healthy lifestyle habits, has to pay largely the same premium as someone who smokes, is obese, and doesn't exercise. And sure enough, life expectancy in the US immediately stalled after the law's implementation: https://www.macrotrends.net/global-metrics/countries/usa/united-states/life-expectancy https://www.macrotrends.net/global-metrics/countries/usa/uni.... Exactly what economics would predict would happen.
- orionsbelt 1y ago
  And what if you, despite being healthy, get diagnosed with cancer right one your employer fails, thus becoming uninsurable? This type of thing happened to people. It’s nice the above can no longer happen. You could, at the same time, still allow insurers to charge a premium to smokers and obese and for other lifestyle risks within one’s control. They are not mutually exclusive.
  - JuniperMesos 1y ago
    The entire system of linking health insurance to one's current employer is bad. I should just be able to buy it with money I earn from doing anything that pays me, just like I do with my car insurance or any other type of insurance.
- tartoran 1y ago
  How about if that is diabetes, or something else that does not depend on lifestyle choices?
  - mlrtime 1y ago
    You're kidding right? Look up how many people have type 2 diabetes, greater than 90%
    - croon 1y ago
      Assuming they mean type 1 yields a better dialogue.
idiotsecant 1y ago
Absolutely. We have this bad habit of hating policies and politicians that make things 10% as good at they tried to do, but shrugging and ignoring politicians and policies that actively make our lives worse. Perfect is ideal. Better than we started with is still better.
- abustamam 1y ago
  In my circles of news and friends, plenty of people are actively hating against politicians and policies that make our lives worse, or who spout dangerous rhetoric (and do nothing else but that). Usually it's just Trump, but my local congressman gets a lot of hate too. Sometimes it is just "orange man bad" but cmon building an opulent ballroom and remodeling a bathroom in marble and having a grand old Halloween party while millions of Americans have no idea how they're gonna have their next meal is some Marie Antoinette shit. Sure that's not really a "policy" per se but it sure makes it look like he doesn't give a shit about policies that actually help the American people.
- 56J8XhH7voFRwPR 1y ago
  The real problem is not politicians per se, its lobbyists. If you want blame the shortcomings of the ACA on anyone blame the insurance lobby. We need to get rid of lobbyists and put in term limits. period. It doesnt matter what party you support neither of them are looking out for your best interests. We should vote for people based on their individual beliefs and policies and not have to worry about what they are going to do in office because they get threatened by their party to vote this way or that way and hold the line ebcause if they dont they will primary you. If we have term limites, getting primaried doesnt matter as much anymore. It shouldnt be a career to be in DC. It should be a public service. The sooner we all realize this and quit picking a tribe the sooner things will get better.
anovikov 1y ago
Isn't it the same thing that made it unaffordable?
- lazyasciiart 1y ago
  No, what made it unaffordable was scrapping the penalty on not having health insurance. If you force health insurance to cover everyone then you also need to force everyone to have health insurance to keep the system balanced. One way to do that is have everyone automatically covered in a public system: rejected. Another way is to tell people they don’t have to sign up for health insurance but they do have to pay into the system.
politicalnit 1y ago
Obama care was not a Democratic win it was another Republican win in a long list of Republican wins, where the dems tried to work with the republicans in good faith and implemented their policies for them. Sadly they realised to late that you should never work with right wing fascists because if you give those people your hand they will take the whole arm.
torginus 1y ago
This is a bit of an aside, but why isn't medical tourism more popular in the US? If you could set aside a couple tens of thousands of dollars, as a rainy day fund, you could get close to the very best possible care for even serious conditions from countries that have highly developed medical tourism sectors. Granted, I acknowledge, that the US will likely still provide better care at the absolute high end, and asking most people to save that much can be quite a tall order, but from what I gather, a lot of people either bankrupt themselves, and end up paying much more than that and/or receive substandard care for conditions where treatment regime is established like treatable forms of cancer or congestive heart failure. I remember Trump blasting Obama about Medicare, and proposing to 'open up' the system, introducing competition to drive prices down instead (which is the real problem of the US system, socially subsidizing it is just a bandaid fix imo). I guess not much has come off that.
- exq 1y ago
  > If you could set aside a couple tens of thousands of dollars Non-starter for the vast majority of Americans.
- rsynnott 1y ago
  The sort of people who can set aside a couple tens of thousands of dollars are also the sort of people who probably have good health insurance through their job. Generally, the US's healthcare problems _mostly_ impact low to middle income people, and they usually can't just magic up 30k or so.
  - seidleroni 1y ago
    100%. I have known a couple of people that did some form of "medical tourism", mostly for expensive dental work. In both cases they did some form of tech contract work as a sole proprietorship and bought their own health insurance (not through a partner). The overlap of people who can save up thousands of dollars for treatment abroad and have poor health insurance is probably not too large.
    - ethbr1 1y ago
_heimdall 1y ago
Had the ACA gone further and actually provided a single payer system, I'd consider the block on denials based on preexisting conditions a win. As it is we have a system of private "insurance" that can't consider the risk level of those being insured. All that means is the companies charge everyone else more to subsidize the cost of those who are more at risk. That bastardizes the whole point of private insurance. I don't want to pay more for my car insurance because the person next door bought a Porsche and the insurance company isn't legally allowed to consider the cost of repairing a Porsche. Don't get me wrong, morally I don't want to see anyone denied health insurance. I also don't want this half-in half-out program where its no longer really private health insurance nor is it a centralized single payer system.
- b3ing 1y ago
  Blame Joe Lieberman for that one.
- matthewdgreen 1y ago
  Health insurance that can discriminate against people based on pre-existing conditions rapidly becomes health insurance you can’t use. Sure, it’ll be cheaper for a few years. Then, with non-negligible probability, you’ll develop a serious condition. At that point the cost becomes anywhere between “high” and “infinite”. If the point is just “private insurance is dumb”, sure, I mostly agree.
  - _heimdall 1y ago
    It isn't insurance if the provider can't consider risk factors for the policy though. If we don't want people's health to be dependent on insurance that's fine, but we should replace it with a system that isn't based on risk at all rather than bastardizing something that still sort of looks like risk-based insurance.
    - ethbr1 1y ago
      > It isn't insurance if the provider can't consider risk factors for the policy though. Insurers are welcome to consider risk factors... for populations in aggregate. It turns their actuarial models into population-subset models instead of individual models. Which is easily the most "fair" (to individuals) option. Allowing insurers to consider individual risk factors (preexisting conditions, genetics, etc.) would make the advertising data mining industry seem quaint. And I don't think any American wants to live in that world. So we can talk about whether insurers should be able to offer lifestyle incentives (yes!), preventative care incentives (yes!), and be backed by catastrophic reinsurers (like mortgages, maybe)... but enrolling people blindly is one of the best things ACA did. (Unless one happens to be young, rich, family-less, healthy, and have no moral compunction about fucking others over for ones own benefit) Also, important unremarked benefit of ACA -- capping maximum insurer "administration" costs. Firsthand from inside the industry as it was implemented, I can tell you that drove efficiency improvements inside insurers, as they couldn't bill for broken, slow, manual processes in additional premiums. Granted, it caused other problems (attempts to self-deal and harvest profits through quasi-related provider / pharmacy entities or Medicare Advantage), but it did focus insurers on being efficient facilitators.
kcplate 1y ago
So why not have just done that?
FeloniousHam 1y ago
Writing as a conservative, the marketplace is also a huge win. I have an employer-subsidized plan I got through healthcare.gov.
AbstractH24 1y ago
How easy people take for granted the status quo and forget that it could be and once was much worse. You see it all the time in the fight for everything.

dbg31415 1y ago

True (*) They can't deny coverage for pre-existing conditions anymore, but insurers still have hundreds of other ways to avoid paying. There's no silver lining in the U.S. healthcare system -- it's built to exhaust, confuse, and bankrupt patients. And it's only gotten worse in recent years. (Will only get worse with the addition of more AI.) Joe Lieberman, a supposed Democrat, killed any real chance for reform we had in our generation. He then left Congress and quickly died -- his legacy is the broken healthcare system we have today, totally rigged against the very patients it's supposed to serve.

ZeroGravitas 1y ago
Joe Lieberman and basically every Republican ever, for decades. And the Republicans on the Supreme Court that hobbled what the Democrats managed to narrowly get through the political process. But sure, direct all the anger for that towards Democrats, that will result in better Healthcare any day now. I hear Trump has concepts of a plan that he's been working on for over a decade that he'll let us know about in just 2 weeks.
- johnnyanmac 1y ago
  I'm so tired of "this plan wasn't perfect, it failed. Democrats suck". And meanwhile the republican plan was to do nothing or actively make things worse than ignoring the problem. Why are some people seemingly hardwired to just blame democrats for any or everything? Because the plans they have don't immediately benefit them, the middle class person who was never down on their luck? Even then, I fail to think of any policy that legitmately benefits the middle class either. Did abortion bans improve your quality of life? Do immigration raids help your 401k? Did that cut to EV credits get you better public transit?
  - ZeroGravitas 1y ago
    Murc's Law https://en.wikipedia.org/wiki/Murc%27s_law https://en.wikipedia.org/wiki/Murc%27s_law > Murc’s Law is typically phrased as: "the widespread assumption that only Democrats have any agency or causal influence over American politics".[5] [6] It reflects a perceived journalistic double standard, where Democrats are held responsible for political outcomes regardless of context, whereas Republican obstruction or extremism is treated as a given. This framing, critics argue, absolves Republicans of responsibility and creates an unbalanced political narrative.
    - meowface 1y ago
      Like half this sub-thread is driving me insane. The deep hatred of Democrats (for decades) from the left is very frustrating to me. They may not be as left-wing as those people might like but they're in fact not nearly as bad as the Republicans.
    - nobody9999 1y ago
      >Murc's Law Which, somehow is a weird outcome of the "Two Santas Theory[0]. I'm not sure why folks actually buy into it, but they apparently do. [0] https://en.wikipedia.org/wiki/Jude_Wanniski#The_Two_Santa_Claus_Theory https://en.wikipedia.org/wiki/Jude_Wanniski#The_Two_Santa_Cl...

slg 1y ago

I'll throw in extending parental coverage to 26. I have a sibling with type 1 diabetes and it's impossible for me to describe the positive impact those two provisions have had on their life. Just because a piece of a legislation includes painful compromises doesn't mean we should ignore its huge wins.

noir_lord 1y ago
That has in part become the issue in modern politics, any compromise no matter how minor is seen as a loss. Neither sides most ardent supporters was willing to accept anything that looked like a compromise and so you end up with things as they are now, with someone where compromise shouldn’t happen because there is no practical compromise. US politics has collapsed down to the scorpion and the frog.
- thunky 1y ago
  > That has in part become the issue in modern politics, any compromise no matter how minor is seen as a loss. Because to those who are now getting hit with huge insurance bills as a direct effect of that compromise, and may have to go without insurance at all, it is a loss. And nothing has been done to address the underlying reasons and bad incentives that have led to this outcome. Which is also a failure.
  - lotsofpulp 1y ago
    >Because to those who are now getting hit with huge insurance bills as a direct effect of that compromise, and may have to go without insurance at all, it is a loss. Because the Republicans slashed the premium tax credits to pay for tax cuts for rich people.
    - mothballed 1y ago
      The fact Republicans wouldn't repeal ACA but would repeal the tax credits just shows both sides prefer it to be broken. Democrats could shove through enough votes to repeal ACA to make health insurance cheaper for lower-risk groups without tax credits; Republicans could re-instate tax credits. Instead we are stuck in this bastardized half-socialized model that gets the worst of all worlds. Politics in the USA has basically gridlocked to it being much cheaper to shit on the other guy than to fix things. In two party system you can actually win by only making the other guy look worse, which only requires breaking things in a way that can be pointed at the other guy, somehow we are stuck in this local minima.

miley_cyrus 1y ago

No that is a huge failure. That is perhaps the biggest failure of Obamacare. That means I, as someone with healthy lifestyle habits, has to pay largely the same premium as someone who smokes, is obese, and doesn't exercise. And sure enough, life expectancy in the US immediately stalled after the law's implementation: https://www.macrotrends.net/global-metrics/countries/usa/united-states/life-expectancy https://www.macrotrends.net/global-metrics/countries/usa/uni.... Exactly what economics would predict would happen.

orionsbelt 1y ago
And what if you, despite being healthy, get diagnosed with cancer right one your employer fails, thus becoming uninsurable? This type of thing happened to people. It’s nice the above can no longer happen. You could, at the same time, still allow insurers to charge a premium to smokers and obese and for other lifestyle risks within one’s control. They are not mutually exclusive.
- JuniperMesos 1y ago
  The entire system of linking health insurance to one's current employer is bad. I should just be able to buy it with money I earn from doing anything that pays me, just like I do with my car insurance or any other type of insurance.
tartoran 1y ago
How about if that is diabetes, or something else that does not depend on lifestyle choices?
- mlrtime 1y ago
  You're kidding right? Look up how many people have type 2 diabetes, greater than 90%
  - croon 1y ago
    Assuming they mean type 1 yields a better dialogue.

idiotsecant 1y ago

Absolutely. We have this bad habit of hating policies and politicians that make things 10% as good at they tried to do, but shrugging and ignoring politicians and policies that actively make our lives worse. Perfect is ideal. Better than we started with is still better.

abustamam 1y ago
In my circles of news and friends, plenty of people are actively hating against politicians and policies that make our lives worse, or who spout dangerous rhetoric (and do nothing else but that). Usually it's just Trump, but my local congressman gets a lot of hate too. Sometimes it is just "orange man bad" but cmon building an opulent ballroom and remodeling a bathroom in marble and having a grand old Halloween party while millions of Americans have no idea how they're gonna have their next meal is some Marie Antoinette shit. Sure that's not really a "policy" per se but it sure makes it look like he doesn't give a shit about policies that actually help the American people.
56J8XhH7voFRwPR 1y ago
The real problem is not politicians per se, its lobbyists. If you want blame the shortcomings of the ACA on anyone blame the insurance lobby. We need to get rid of lobbyists and put in term limits. period. It doesnt matter what party you support neither of them are looking out for your best interests. We should vote for people based on their individual beliefs and policies and not have to worry about what they are going to do in office because they get threatened by their party to vote this way or that way and hold the line ebcause if they dont they will primary you. If we have term limites, getting primaried doesnt matter as much anymore. It shouldnt be a career to be in DC. It should be a public service. The sooner we all realize this and quit picking a tribe the sooner things will get better.

anovikov 1y ago

Isn't it the same thing that made it unaffordable?

lazyasciiart 1y ago
No, what made it unaffordable was scrapping the penalty on not having health insurance. If you force health insurance to cover everyone then you also need to force everyone to have health insurance to keep the system balanced. One way to do that is have everyone automatically covered in a public system: rejected. Another way is to tell people they don’t have to sign up for health insurance but they do have to pay into the system.

politicalnit 1y ago

Obama care was not a Democratic win it was another Republican win in a long list of Republican wins, where the dems tried to work with the republicans in good faith and implemented their policies for them. Sadly they realised to late that you should never work with right wing fascists because if you give those people your hand they will take the whole arm.

torginus 1y ago

This is a bit of an aside, but why isn't medical tourism more popular in the US? If you could set aside a couple tens of thousands of dollars, as a rainy day fund, you could get close to the very best possible care for even serious conditions from countries that have highly developed medical tourism sectors. Granted, I acknowledge, that the US will likely still provide better care at the absolute high end, and asking most people to save that much can be quite a tall order, but from what I gather, a lot of people either bankrupt themselves, and end up paying much more than that and/or receive substandard care for conditions where treatment regime is established like treatable forms of cancer or congestive heart failure. I remember Trump blasting Obama about Medicare, and proposing to 'open up' the system, introducing competition to drive prices down instead (which is the real problem of the US system, socially subsidizing it is just a bandaid fix imo). I guess not much has come off that.

exq 1y ago
> If you could set aside a couple tens of thousands of dollars Non-starter for the vast majority of Americans.
rsynnott 1y ago
The sort of people who can set aside a couple tens of thousands of dollars are also the sort of people who probably have good health insurance through their job. Generally, the US's healthcare problems _mostly_ impact low to middle income people, and they usually can't just magic up 30k or so.
- seidleroni 1y ago
  100%. I have known a couple of people that did some form of "medical tourism", mostly for expensive dental work. In both cases they did some form of tech contract work as a sole proprietorship and bought their own health insurance (not through a partner). The overlap of people who can save up thousands of dollars for treatment abroad and have poor health insurance is probably not too large.
  - ethbr1 1y ago

_heimdall 1y ago

Had the ACA gone further and actually provided a single payer system, I'd consider the block on denials based on preexisting conditions a win. As it is we have a system of private "insurance" that can't consider the risk level of those being insured. All that means is the companies charge everyone else more to subsidize the cost of those who are more at risk. That bastardizes the whole point of private insurance. I don't want to pay more for my car insurance because the person next door bought a Porsche and the insurance company isn't legally allowed to consider the cost of repairing a Porsche. Don't get me wrong, morally I don't want to see anyone denied health insurance. I also don't want this half-in half-out program where its no longer really private health insurance nor is it a centralized single payer system.

b3ing 1y ago
Blame Joe Lieberman for that one.
matthewdgreen 1y ago
Health insurance that can discriminate against people based on pre-existing conditions rapidly becomes health insurance you can’t use. Sure, it’ll be cheaper for a few years. Then, with non-negligible probability, you’ll develop a serious condition. At that point the cost becomes anywhere between “high” and “infinite”. If the point is just “private insurance is dumb”, sure, I mostly agree.
- _heimdall 1y ago
  It isn't insurance if the provider can't consider risk factors for the policy though. If we don't want people's health to be dependent on insurance that's fine, but we should replace it with a system that isn't based on risk at all rather than bastardizing something that still sort of looks like risk-based insurance.
  - ethbr1 1y ago
    > It isn't insurance if the provider can't consider risk factors for the policy though. Insurers are welcome to consider risk factors... for populations in aggregate. It turns their actuarial models into population-subset models instead of individual models. Which is easily the most "fair" (to individuals) option. Allowing insurers to consider individual risk factors (preexisting conditions, genetics, etc.) would make the advertising data mining industry seem quaint. And I don't think any American wants to live in that world. So we can talk about whether insurers should be able to offer lifestyle incentives (yes!), preventative care incentives (yes!), and be backed by catastrophic reinsurers (like mortgages, maybe)... but enrolling people blindly is one of the best things ACA did. (Unless one happens to be young, rich, family-less, healthy, and have no moral compunction about fucking others over for ones own benefit) Also, important unremarked benefit of ACA -- capping maximum insurer "administration" costs. Firsthand from inside the industry as it was implemented, I can tell you that drove efficiency improvements inside insurers, as they couldn't bill for broken, slow, manual processes in additional premiums. Granted, it caused other problems (attempts to self-deal and harvest profits through quasi-related provider / pharmacy entities or Medicare Advantage), but it did focus insurers on being efficient facilitators.

kcplate 1y ago

So why not have just done that?

FeloniousHam 1y ago

Writing as a conservative, the marketplace is also a huge win. I have an employer-subsidized plan I got through healthcare.gov.

AbstractH24 1y ago

How easy people take for granted the status quo and forget that it could be and once was much worse. You see it all the time in the fight for everything.