7 ms·

Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?

by p0w3n3d 11mo ago

ponooqjoqo 11mo ago
ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population. It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
runako 11mo ago
Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely. Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
- dboreham 11mo ago
  Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.
  - runako 11mo ago
    Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.
    - nradov 11mo ago
      You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.
  - ethbr1 11mo ago
    Medicare Advantage? https://m.youtube.com/watch?v=Ejoi9yfLVCc https://m.youtube.com/watch?v=Ejoi9yfLVCc
- johnnienaked 11mo ago
  Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes
  - s5300 11mo ago
    [dead]
  - vunderba 11mo ago
    And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right? As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
    - tirant 11mo ago
      I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot. In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. In this day and age public healthcare system are not efficient and bill the wrong people. They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners. However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country. These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system. Private systems work better because each citizen pays into his old age health coverage during his young years.
      - sumuyuda 11mo ago
        > In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
- xtiansimon 11mo ago
  Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/
  - ethbr1 11mo ago
    Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure. I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling. Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).
dogemaster2028 11mo ago
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
- Jordan-117 11mo ago
  The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative states. And Republicans in Congress removed the individual mandate, which enabled healthy people to go without coverage, raising prices for everyone else.
  - ethbr1 11mo ago
    It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity. You shouldn't change all the parts in an engine to different specifications at the same time. The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward. The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!) The previous system was broken. The current system is less broken. It's possible to create an even less broken future system. The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'
    - dogemaster2028 11mo ago
      In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward. Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off. You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future. There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them. Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.
teaearlgraycold 11mo ago
They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.
nielsbot 11mo ago
You comment sounds like snark but I understand if you don't know what Obamacare is. (And I'm not an expert so hopefully people will correct any mistakes) "Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse. On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.
- thallium205 11mo ago
  All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things.
  - _DeadFred_ 11mo ago
    Strangely it actually was based on the GOPs 'Romneycare' that was promoted by The Heritage Foundation.
    - ethbr1 11mo ago
      Qft. Many of the provisions in ACA are direct GOP asks from the bipartisan negotiations around it... before the party decided to unanimously vote against it at the 11th hour.
    - nielsbot 11mo ago
      This is exactly what I was referring to. And I pointed that out to contrast with something more leftist, like government single payer.
freeqaz 11mo ago
Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you: > Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.

Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?

by p0w3n3d 11mo ago

Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?

ObamaCare (actually the Affordable Care Act: ACA) is a band-aid solution. It's a way to at least ensure that everyone has a pathway to insurance if they have enough money. Basically, the government negotiates some plans with private insurers and makes them available to the general population. It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.

runako 11mo ago

Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely. Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.

dboreham 11mo ago
Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.
- runako 11mo ago
  Given that older people tend to be some of the main cost drivers in healthcare, it's sort of silly that we cover them and then refuse to allow younger (cheaper) people to opt in to the same system & perhaps defray costs that way.
  - nradov 11mo ago
    You're missing a key piece. Medicare only sort of works because the larger healthcare system has a hidden cross subsidy where commercial health plans reimburse providers at much higher rates. In some cases providers are actually losing money caring for Medicare beneficiaries. We already have a problem with doctors refusing to accept new Medicare patients, and if we moved more patients from commercial insurance to Medicare then that provider shortage would only get worse.
- ethbr1 11mo ago
  Medicare Advantage? https://m.youtube.com/watch?v=Ejoi9yfLVCc https://m.youtube.com/watch?v=Ejoi9yfLVCc
johnnienaked 11mo ago
Health care is fine here if you have a decent job. Health care is not that great in public systems and you still pay for it with higher taxes
- s5300 11mo ago
  [dead]
- vunderba 11mo ago
  And naturally you make this absolute claim because you've undoubtably lived in more countries than just the United States, right? As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
  - tirant 11mo ago
    I have lived in 3 countries with socialized health care system and the public systems were just average to poor, and costing me a lot. In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. In this day and age public healthcare system are not efficient and bill the wrong people. They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners. However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country. These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system. Private systems work better because each citizen pays into his old age health coverage during his young years.
    - sumuyuda 11mo ago
      > In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people. The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
xtiansimon 11mo ago
Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/ https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/
- ethbr1 11mo ago
  Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure. I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling. Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).

dogemaster2028 11mo ago

Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.

Jordan-117 11mo ago
The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative states. And Republicans in Congress removed the individual mandate, which enabled healthy people to go without coverage, raising prices for everyone else.
- ethbr1 11mo ago
  It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity. You shouldn't change all the parts in an engine to different specifications at the same time. The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward. The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!) The previous system was broken. The current system is less broken. It's possible to create an even less broken future system. The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'
  - dogemaster2028 11mo ago
    In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward. Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off. You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future. There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them. Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.

teaearlgraycold 11mo ago

They stripped it of most meaningful changes to get it passed. What it ended up being was kind of the worst of both worlds. A federally related marketplace for private healthcare insurance. They did however ban coverage limits on “pre-existing conditions”. Before Obamacare an insurer could whine that you had cancer before signing up and refuse to cover your cancer care.

nielsbot 11mo ago

You comment sounds like snark but I understand if you don't know what Obamacare is. (And I'm not an expert so hopefully people will correct any mistakes) "Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse. On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.

thallium205 11mo ago
All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things.
- _DeadFred_ 11mo ago
  Strangely it actually was based on the GOPs 'Romneycare' that was promoted by The Heritage Foundation.
  - ethbr1 11mo ago
    Qft. Many of the provisions in ACA are direct GOP asks from the bipartisan negotiations around it... before the party decided to unanimously vote against it at the 11th hour.
  - nielsbot 11mo ago
    This is exactly what I was referring to. And I pointed that out to contrast with something more leftist, like government single payer.

freeqaz 11mo ago

Unfortunately not. It's still very broken, and next year it will be worse for a ton of people. I got AI to write a short answer for you: > Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.