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ACA enshrined the worst parts of the American healthcare system for years to come. It is a politicized victory that is the best solution for no American citizen

ACA enshrined the worst parts of the American healthcare system for years to come. It is a politicized victory that is the best solution for no American citizens. Places I’ve been with fully privatized healthcare or single payer are both significantly better for consumers. Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come.

lotsofpulp 7mo ago
> Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come. Why do their stocks underperform so badly? https://imgur.com/S8bNSM2 https://imgur.com/S8bNSM2
- rybosworld 7mo ago
  Why would a 3-year stock chart be indicative of underperformance?
  - lotsofpulp 7mo ago
    It is a 5 year chart, and the 10 year is not free on that website. You can find out similar results for longer periods here: https://dqydj.com/stock-return-calculator/ https://dqydj.com/stock-return-calculator/ https://dqydj.com/sp-500-return-calculator/ https://dqydj.com/sp-500-return-calculator/
ipsento606 7mo ago
> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be
- deleted 7mo ago
  [deleted]
- CGMthrowaway 7mo ago
  We traded the cruelty of Exclusion for the cruelty of Extraction.
  - tptacek 7mo ago
    What does that mean?
    - deleted 7mo ago
      [deleted]
    - CGMthrowaway 7mo ago
      Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
      - raw_anon_1111 7mo ago
        You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
        CGMthrowaway 7mo ago
        We are talking past each other. When I said moral hazard I'm talking about adverse selection(1), my bad if that was unclear. And I was responding to some comments about denial for pre-existing conditions, which as you point out is irrelevant for continuous coverage group policies. Removing the mandate penalty without also adjusting the pre-existing condition protections did introduce adverse selection in the current regime. None of that disqualifies my argument about the current state of affairs though re the business model of modern insurance companies If you were just looking to shout "dems good GOP bad" and find others who agree with you, that's cool too. (1)https://en.wikipedia.org/wiki/Adverse_selection https://en.wikipedia.org/wiki/Adverse_selection
- twoodfin 7mo ago
  Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?
  - ChadNauseam 7mo ago
    It interacts badly with insurance being offered as workplace benefit. If you quit or lose your job, you'd lose your health insurance. And any plan you signed up for after that would then treat you as "pre-existing embers" and expect you to pay accordingly. The bundling of health insurance with workplace seems like the healthcare original sin to me. Obama couldn't change that, so the ACA redesigned the system to work with it. Despite being called insurance, health insurance is no longer really viewed or designed to be any kind of insurance. Instead, it's supposed to be Netflix for healthcare. You pay a flat rate, and then get unlimited healthcare. Obviously, the issue with this is that if you don't need healthcare you can just not sign up for the subscription. So the ACA tried to solve this by requiring everyone to sign up. Once everyone is required to sign up, it's not right to discriminate against preexisting conditions. It may not be an especially good system, but it is coherent.
    - mjevans 7mo ago
      The US is allergic to taxes. Maybe it's a marketing thing. Benefits paid for by society. Maybe a department of Return on Investment. See what those taxes pay for. Contrast to buying private versions of the services at the same SLA or better.
      - twodave 7mo ago
        It’s more that the US is more like a collection of 50 little countries, and it’s supposed to be hard to accomplish much at a federal level. That separation has eroded a bit in the last 50 years but it’s still very much a part of our political ideology.
  - raw_anon_1111 7mo ago
    If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. But you do realize that the entire idea of not being able to get insurance because of pre-existing conditions is completely unique to the US? Costa Rica for instance (where I am right now for a month and half) allows anyone to become a resident as long as you have guaranteed income of around $2000 a month or you deposit $60K into a local bank account and they arrange monthly disbursements and you pay 15% of your stated income to CAJA. Healthcare is both better and more affordable here. The same is true for Panama. Why can’t the US figure this out?
- antisthenes 7mo ago
  > people have forgotten how bad things used to be Not really, because whereas before things were bad for people with pre-existing conditions, now they are really bad for everyone. People are paying exorbitant prices either for insurance, for routine health care stuff, or for both. There was no free lunch, so we traded some health care for the chronically ill, for slightly less healthcare for everyone else. The insurance companies make sure it's an extractive zero-sum game in terms of actual healthcare provided.
  - raw_anon_1111 7mo ago
    When I was looking for healthcare after my employer went tits up right before the ACA went into affect, I couldn’t buy insurance at any price because of a pre-existing condition. Mine you that I have had my ore-existing condition since birth in 1974, had one surgery my entire life - foot surgery in 1996 - and this was 2011 and now I’m 52 and still haven’t had any complications from it and don’t expect to. I was also a part time fitness instructor, runner and could past any of the standardized fitness assessment standards for someone who was 5 years younger as far as push ups, sit ups, running etc. I had a contract so I could have easily paid more based on risk. Before anyone mentions COBRA, that’s only an option if your former group plan still exists and it didn’t when the company went out of business. Just looking, even now the ACA Silver for my wife and I would be around $800 a month in my state. Even ignoring medical costs have gone up more than inflation, that would have been $550 a month in 2011 if the ACA had been available.
deleted 7mo ago
[deleted]

lotsofpulp 7mo ago

> Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come. Why do their stocks underperform so badly? https://imgur.com/S8bNSM2 https://imgur.com/S8bNSM2

rybosworld 7mo ago
Why would a 3-year stock chart be indicative of underperformance?
- lotsofpulp 7mo ago
  It is a 5 year chart, and the 10 year is not free on that website. You can find out similar results for longer periods here: https://dqydj.com/stock-return-calculator/ https://dqydj.com/stock-return-calculator/ https://dqydj.com/sp-500-return-calculator/ https://dqydj.com/sp-500-return-calculator/

ipsento606 7mo ago

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

deleted 7mo ago
[deleted]
CGMthrowaway 7mo ago
We traded the cruelty of Exclusion for the cruelty of Extraction.
- tptacek 7mo ago
  What does that mean?
  - deleted 7mo ago
    [deleted]
  - CGMthrowaway 7mo ago
    Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
    - raw_anon_1111 7mo ago
      You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
      - CGMthrowaway 7mo ago
        We are talking past each other. When I said moral hazard I'm talking about adverse selection(1), my bad if that was unclear. And I was responding to some comments about denial for pre-existing conditions, which as you point out is irrelevant for continuous coverage group policies. Removing the mandate penalty without also adjusting the pre-existing condition protections did introduce adverse selection in the current regime. None of that disqualifies my argument about the current state of affairs though re the business model of modern insurance companies If you were just looking to shout "dems good GOP bad" and find others who agree with you, that's cool too. (1)https://en.wikipedia.org/wiki/Adverse_selection https://en.wikipedia.org/wiki/Adverse_selection
twoodfin 7mo ago
Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?
- ChadNauseam 7mo ago
  It interacts badly with insurance being offered as workplace benefit. If you quit or lose your job, you'd lose your health insurance. And any plan you signed up for after that would then treat you as "pre-existing embers" and expect you to pay accordingly. The bundling of health insurance with workplace seems like the healthcare original sin to me. Obama couldn't change that, so the ACA redesigned the system to work with it. Despite being called insurance, health insurance is no longer really viewed or designed to be any kind of insurance. Instead, it's supposed to be Netflix for healthcare. You pay a flat rate, and then get unlimited healthcare. Obviously, the issue with this is that if you don't need healthcare you can just not sign up for the subscription. So the ACA tried to solve this by requiring everyone to sign up. Once everyone is required to sign up, it's not right to discriminate against preexisting conditions. It may not be an especially good system, but it is coherent.
  - mjevans 7mo ago
    The US is allergic to taxes. Maybe it's a marketing thing. Benefits paid for by society. Maybe a department of Return on Investment. See what those taxes pay for. Contrast to buying private versions of the services at the same SLA or better.
    - twodave 7mo ago
      It’s more that the US is more like a collection of 50 little countries, and it’s supposed to be hard to accomplish much at a federal level. That separation has eroded a bit in the last 50 years but it’s still very much a part of our political ideology.
- raw_anon_1111 7mo ago
  If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. But you do realize that the entire idea of not being able to get insurance because of pre-existing conditions is completely unique to the US? Costa Rica for instance (where I am right now for a month and half) allows anyone to become a resident as long as you have guaranteed income of around $2000 a month or you deposit $60K into a local bank account and they arrange monthly disbursements and you pay 15% of your stated income to CAJA. Healthcare is both better and more affordable here. The same is true for Panama. Why can’t the US figure this out?
antisthenes 7mo ago
> people have forgotten how bad things used to be Not really, because whereas before things were bad for people with pre-existing conditions, now they are really bad for everyone. People are paying exorbitant prices either for insurance, for routine health care stuff, or for both. There was no free lunch, so we traded some health care for the chronically ill, for slightly less healthcare for everyone else. The insurance companies make sure it's an extractive zero-sum game in terms of actual healthcare provided.
- raw_anon_1111 7mo ago
  When I was looking for healthcare after my employer went tits up right before the ACA went into affect, I couldn’t buy insurance at any price because of a pre-existing condition. Mine you that I have had my ore-existing condition since birth in 1974, had one surgery my entire life - foot surgery in 1996 - and this was 2011 and now I’m 52 and still haven’t had any complications from it and don’t expect to. I was also a part time fitness instructor, runner and could past any of the standardized fitness assessment standards for someone who was 5 years younger as far as push ups, sit ups, running etc. I had a contract so I could have easily paid more based on risk. Before anyone mentions COBRA, that’s only an option if your former group plan still exists and it didn’t when the company went out of business. Just looking, even now the ACA Silver for my wife and I would be around $800 a month in my state. Even ignoring medical costs have gone up more than inflation, that would have been $550 a month in 2011 if the ACA had been available.

deleted 7mo ago

[deleted]