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>The Data: Before the ACA, Maine implemented this. Anthem requested a 20% rate hike due to adverse selection. After the pool was implemented, the rate hike drop

>The Data: Before the ACA, Maine implemented this. Anthem requested a 20% rate hike due to adverse selection. After the pool was implemented, the rate hike dropped to under 2%. >This shows we can protect the sick without forcing the healthy to pay $25k/year premiums to an oligopoly. So in effect give the oligopoly tax money so they keep their rates the same for the sick and the well? Isn't that what Congress is basically currently fighting over (federal money vs. state?) Congress also intentionally removed the unpopular requirement to have to buy insurance (either through your employer or the ACA market), essentially re-creating one of the death-spiral conditions in the first place. It's been the Republican goal all along to get the ACA to die in a death spiral so we can go back to forcing people into medical bankruptcy, like God intended.

kmundy 10mo ago
Well, the subsidy just buys us some time to stabilize the risk pool. Meanwhile, the ACO+Factory model is emerging, which flips the incentives; changes the way the product is consumed, so we stop overpaying in the first place.
- GlibMonkeyDeath 10mo ago
  I agree we need to remove the perverse incentives across the entire system. I also agree the current ACA subsidies are a band-aid. It's incredibly frustrating because this is a solved problem - even just fixing the most egregious flaws in the ACA would be a huge improvement. I am very skeptical, though, that in my lifetime American voters will ever be unified enough again to take on the de facto doctors union, the health insurer oligopoly, and the pharmaceutical companies, all of whom currently benefit from the broken system, and basically control the government top to bottom.
  - kmundy 10mo ago
    You’re right—Congress is the bottleneck for the important stuff (Residency Cap, MLR). And the lobby is massive. I'm a tad more hopeful than you though. I'm hoping that if we all have a shared understanding of how these well intentioned rules (MLR, GME caps) are unwittingly benefitting insurers, it helps bring some clarity into what precisely needs to change & will, perhaps, build some pressure on legislators.

kmundy 10mo ago

Well, the subsidy just buys us some time to stabilize the risk pool. Meanwhile, the ACO+Factory model is emerging, which flips the incentives; changes the way the product is consumed, so we stop overpaying in the first place.

GlibMonkeyDeath 10mo ago
I agree we need to remove the perverse incentives across the entire system. I also agree the current ACA subsidies are a band-aid. It's incredibly frustrating because this is a solved problem - even just fixing the most egregious flaws in the ACA would be a huge improvement. I am very skeptical, though, that in my lifetime American voters will ever be unified enough again to take on the de facto doctors union, the health insurer oligopoly, and the pharmaceutical companies, all of whom currently benefit from the broken system, and basically control the government top to bottom.
- kmundy 10mo ago
  You’re right—Congress is the bottleneck for the important stuff (Residency Cap, MLR). And the lobby is massive. I'm a tad more hopeful than you though. I'm hoping that if we all have a shared understanding of how these well intentioned rules (MLR, GME caps) are unwittingly benefitting insurers, it helps bring some clarity into what precisely needs to change & will, perhaps, build some pressure on legislators.