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We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of t

We've been down this road. ACA was predicated on studies like this, to no avail (it turns out that intense opposition chips away at it over time regardless of these studies). I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I'm not saying that this is what is happening now, but I am saying that calls for universal health coverage, no matter how correct and well supported, are going to probably face the same obstacles they did last time, so we need new coalitions and implementation proposals if we're going to give it a go again. It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to.

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_heimdall 2mo ago
These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable. Go after any one of those and we'd make a lot more headway than trying to ram through a universal, government-run healthcare or insurance program. And yes, such a program could impact the above topics, but it doesn't have to and could make any of them worse.
- loeg 2mo ago
  Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.
  - quacked 2mo ago
    That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
    - whimsicalism 2mo ago
      You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing. 0: https://en.wikipedia.org/wiki/Roemer%27s_law https://en.wikipedia.org/wiki/Roemer%27s_law
  - t-writescode 2mo ago
    Citation needed (per capita please). Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all. And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)
    - SoftTalker 2mo ago
      I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it." I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years. I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.
      - TimorousBestie 2mo ago
        Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.
        SoftTalker 2mo ago
        An unexpected car replacement would put most people into serious debt. And there's no insurance for that. People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.
        TimorousBestie 2mo ago
        So you didn’t want a citation after all. Alas.
  - dboreham 2mo ago
    In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.
  - nradov 2mo ago
    Something like 20% of healthcare services are "low value care" which aren't justified by evidence-based medicine criteria and may even harm the patient. Regardless of the financing system we could free up a lot of capacity and slash costs by eliminating that low value care. Of course in practice it's difficult to do that at scale. https://www.bloomsbury.com/us/price-we-pay-9781635575910/ https://www.bloomsbury.com/us/price-we-pay-9781635575910/
- hx8 2mo ago
  > The problem with US healthcare isn't who pays for it, its how damn expensive it is Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.
  - _heimdall 2mo ago
    (1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.
    - hx8 2mo ago
      1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for. 2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."
      - _heimdall 2mo ago
        That's a great question, and one that should receive similar funding and attention to properly compare. My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).
    - dmschulman 2mo ago
      There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things). Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savings. One example, hospitals are required to treat patients whether or not they hold insurance. The hospital foots the bill for that care and it's a major reason why hospitals shut down (especially in underserved communities). Getting more people on insurance plans was a direct factor is keeping many struggling hospitals and health systems afloat. https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/ https://www.statnews.com/2019/03/22/affordable-care-act-cont... https://www.networkforphl.org/news-insights/the-affordable-care-act-reflections-on-10-years/ https://www.networkforphl.org/news-insights/the-affordable-c... https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act https://www.cbpp.org/research/health/chart-book-accomplishme...
- nsxwolf 2mo ago
  We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.
  - jtbayly 2mo ago
    Especially when the buyer and seller are the same huge monopoly entity, but the payer is “somebody else,” the incentives are completely perverse.
- Retric 2mo ago
  No, it’s not a question of who pays for it but who benefits. You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.
  - QuercusMax 2mo ago
    Companies don't hesitate to lay people off when their jobs aren't needed. I don't see why these parasitic insurance companies need to stay in business.
  - _heimdall 2mo ago
    No one benefits when there's a single player in an industry. When that single player also owns your taxes and military, its a risk we should at least avoid if at all possible.
    - Retric 2mo ago
      Let’s try and deal with actual facts here. If you disagree then you should be able to post some actual data in terms of lifespans or costs that says otherwise. There’s multiple healthcare systems around the world, single payer results in vastly less administrative and thus overall spending and equal or better outcomes overall. So by objective criteria the average person massively benefits from single payer healthcare.
- hnlmorg 2mo ago
  The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems. The problem is you either need to regular or nationalise. And neither of those are particularly “American”.
  - _heimdall 2mo ago
    I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.
    - mindslight 2mo ago
      It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract!), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the grocery store involved "paying" some token amount at the cashier for their time to put your items in bags, then for the food you received shakedown bills for years afterwards, that you had to spend time going through your old documentation to refute and bargain down. Absurd. Regardless of "insurance", who is ultimately paying, or subsidies to provide a baseline of care - there needs to be reform that mandates simple up-front prices, constant per-provider regardless who is paying, and ruling out any other theory of billing. Doctors throw up their hands and act like they're dealing with some special problems, but there are plenty of other industries we can look at for the dynamics of how to handle routine procedures versus emergencies (and knowns vs unknowns) in a consensual and market-responsive manner.
      - nradov 2mo ago
        That's all true, but from a practical standpoint providers really have no way to accurately estimate a patient's out-of-pocket financial responsibility in advance. The current HIPAA adopted standard transactions don't allow for sending a prospective claim. So all they can realistically do is perform the procedure, submit a claim to the patient's health plan, wait for it to (maybe) be paid, and then send a bill to the patient for the balance. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct... The good news is that CMS is working on an update to those standards which will at least make prospective claims technically possible. Although it may take years until that functionality is widely implemented.
- giantg2 2mo ago
  "The problem with US healthcare isn't who pays for it, its how damn expensive it is." And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers
  - _heimdall 2mo ago
    Exactly. I'd at least want to see similarly funded studies comparing solves for underlying causes beyond just insurance companies not being nationalized. Similarly we could look into the likely cost of over medicating our people, and the atrocities we call food in grocery stores.
- larkost 2mo ago
  I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money. It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit). Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.
  - _heimdall 2mo ago
    I understand that theres an argument for removing private insurance companies in favor of thr government can cut costs. It can also increase them. I'd argue that the primary issue with insurance costs today is the lack of market competition, obscurity of what costs and prices are, and government protections that prevent insurance companies from being legally liable for many of the problems they cause. Corruption and monopolistic practices is a big deal in healthcare, for example. We'd be better off, in my opinion, by solving that rather than killing an entire private industry and hoping our government can continue to do it better indefinitely.
    - onraglanroad 2mo ago
      >theres an argument for removing private insurance companies in favor of thr government I don't see why you'd need to do that. Just expand medicare to everyone and if people want to also buy private insurance they can. They'd just need to be more competitive and add significant value, which they don't currently do.
- SpicyLemonZest 2mo ago
  It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue-shield-anesthesia-anthem https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.
  - _heimdall 2mo ago
    The disconnect between prices and end consumers is itself a huge problem. I should know what care costs before I get it, and I should know how much my instance company is paying on my behalf before I get care. For prices to be sane we need people being able to compare prices, decide what care they want and can afford, etc. Our prices are so high because its a closed market acting as though it were a free/open market being driven in part by customer decisions.
    - SpicyLemonZest 2mo ago
      I think that’s a reasonable model to want, but it’s what we call “preauthorization”, and many patients along with most doctors absolutely hate it. In order to know with certainty what your care will cost and how much your insurance company will pay, the doctor has to contact them in between deciding what treatment you should have and giving you the treatment. You can and I do solve that annoyance with an HMO, where the doctors and insurance can communicate more effectively because they’re part of the same organization. But that also means it’s difficult or impossible for me to get the kind of care that a normal insurance company would hesitate to approve.
      - _heimdall 2mo ago
        Preauthorization is a bit different, and yes I can see care providers hating it. Its possible for a provider to know ahead of time that providing a saline IV costs $60, for example. Its also possible to have health care policies that approve any treatment deemed necessary at any healthcare provider, or at any healthcare provider in network if that concept was still a thing. We don't have to have a preauthorisation step where doctors are expected to ask insurance companies if they will approve a certain treatment for a certain patient before it can be done. That is a particularly terrible implementation if you ask me.
- bcrosby95 2mo ago
  I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends. My favorite was a friend who had to deliver her baby, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.
- hintymad 2mo ago
  > The problem with US healthcare isn't who pays for it, its how damn expensive it is Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.
  - autoexec 2mo ago
    Universal healthcare would cut down on the paperwork needed and provide opportunities to simplify it
  - HDThoreaun 2mo ago
    medicare is basically the biggest culprit for the "too much paperwork" stuff. A m4a plan that doesnt involve capitation would have even more paperwork than the current system does.
- tptacek 2mo ago
  This paper is based on numbers from the CMS NHE. Here are those numbers summarized (up to 2023): https://nationalhealthspending.org/ https://nationalhealthspending.org/ I haven't finished reading the paper and have no opinions on it (other than that most successful universal systems aren't single-payer) but if we start from actual numbers the discussion will be better.
Tepix 2mo ago
> if your solution requires perpetual majority control I think once universal health coverage is established, it amounts to political suicide to try to take it away again.
- TimorousBestie 2mo ago
  I don’t think “political suicide” exists anymore.
  - shigawire 2mo ago
    We still have Social Security for now. Entitlements are sticky for better or for worse.
    - warkdarrior 2mo ago
      Social Security in its current form will be gone within two years. Instead you will be required to pay a contribution (just as you are now) but the money will be managed by a private company who will charge fees and provide no guarantees. Current retirees will get to keep the current arrangement, everyone else will be moved to the privately managed Social Security option.
      - xboxnolifes 2mo ago
        Is this based on something real happening within 2 years, or just a continuation of the 30 year sentiment that social security will be gone before my generation will get access to it?
      - AstralSerenity 2mo ago
        People have been saying this forever. It will never happen. Republicans and Democrats alike love Social Security. All that needs to be done to fix it is raise the cap.
  - cogman10 2mo ago
    We still have Medicare, Medicaid, and social security. Even though each program has been weakened, none of them have been abolished and they can all be restored. Heck, we still have SNAP, even though it's almost universally hated by republicans.
mapt 2mo ago
"If your solution requires addressing the slow-burn civil war, your solution is just a campaign slogan". Essentially, all solutions require addressing the slow-burn civil war, which is today capable of of subsuming any issue. Not a single policy issue can realistically be addressed while the rabid 800lb gorilla is in the room. That gorilla is not Trump, that gorilla is Heritage, Fox News, Koch, et al.
epistasis 2mo ago
ACA has saved tons of lives. Due to the intense opposition, it was not structured in a way that could save money, but rather structured in the way that it could get through congress. Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibilities, especially for entrepreneurs. There's a very clear type of fallacy you are engaging in here that only works in politics: you're taking a vague general idea X, ignoring all particulars, and then lumping an idea Y together as if they identical and that any change in that general direction of Y could ever be different than what happened with X. There's no intellectual rigor or honesty in that sort of thinking, yet it somehow pops up throughout all of politics.
- strictnein 2mo ago
  > ACA has saved tons of lives It was the Medicaid expansion that has been cited as saving lives [0]. An expansion that has almost nothing to do with the rest of the ACA. > "There's a very clear type of fallacy you are engaging ... There's no intellectual rigor or honesty in that sort of thinking" So you're claiming that the person who posted that is not only falling into a fallacy, but they are neither intellectually rigorous or honest? I think you're reading a lot into their comment which seemed pretty benign, but possibly contrary to your viewpoint? [0] https://news.uchicago.edu/story/new-research-shows-medicaid-expansion-reduced-mortality-low-income-adults https://news.uchicago.edu/story/new-research-shows-medicaid-...
  - epistasis 2mo ago
    > An expansion that has almost nothing to do with the rest of the ACA. That's a very strange assertion, it's literally "the ACA medicaid expansion" and was a key part of the whole thing. I'm saying most political argumentation is dishonest and not intellectually rigorous, and that's what the comment was doing. It wasn't arguing based on facts or data or actual specifics, but rather according to vague political ideologies. That's one reason that I believe politics are discouraged on HN. It turns off our brains and we start using less interesting or useful ways of thinking.
saulpw 2mo ago
ACA is not Universal Health Coverage. So this would be different enough. And you don't need perpetual majority control, only sensible politicians for about a generation (like FDR/Truman/Eisenhower/JFK) to lock in a popular entitlement.
- apothegm 2mo ago
  Sensible politicians? In the US? In this era? For a _generation_???
  - saulpw 2mo ago
    I agree it would be very difficult, but still a lot easier than 'perpetual'.
- strictnein 2mo ago
  FDR and "sensible" is always funny to me. The sensible politician that imprisoned Japanese Americans, destroying the lives of 120,000 of our fellow citizens.
- robertoandred 2mo ago
  It was pretty close until republicans pulled back Medicaid.
boutell 2mo ago
This is exactly the argument that gave us the Affordable Care Act. It was literally a republican plan from Massachusetts. It was supposed to be broadly acceptable and that's why it was implemented with a billion compromises. But the Republicans called the Democrats commies anyway and refused to participate. And that has been their playbook ever since. That is what they are going to do, no matter what we propose. So we may as well propose actual universal healthcare. But I agree with you that we need to create strong majorities to keep it in place until it reaches the kind of momentum it has in Canada or Sweden and opposition to it becomes a practical impossibility, like opposing social security. Maybe someday we can have a system where losing health insurance isn't a motivation for not starting a company. Our current system is a complete disaster for entrepreneurial capitalism.
- saghm 2mo ago
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lvl155 2mo ago
You mean obstacles from politicians who took money from the healthcare industry. That’s how we ended up with PPACA and they used it to justify massive cost increases and consolidations. They passed that junk to save face and now healthcare is far worse. But we “closed” the donut hole, right? Quite literally made everyone worse off and no one wants to talk about it. I still can’t believe they allowed payors such as UNH to buy up everything without ANY proper investigations during that period.
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saghm 2mo ago
I mean, the original plan for what became ACA was single payer. They didn't have the votes from the moderate democrats though, which is why the "private plans on public exchanges" became a thing instead. You're not wrong at at least for the forseeable future, single payer does seem untenable politically, but I'd argue that dismissing studies like this on the basis that it needs solved before debating it on its merits is circular, because the only plausible political objection to a policy like this is financial. If you reflexively claim that nothing without broad consensus appeal at a given point in time is worth discussing, you're essentially arguing in favor of freezing our public policy to whatever the current public opinion is today. I don't think you need to go very far back in history to see some pretty striking examples of why that would be undesirable.
- while_true_ 2mo ago
  They had 59 votes from Democrats for the public option, not single payer. Public option is to let people choose either a non-profit government insurance plan or private insurers. They needed 60 votes to break a Republican filibuster. Joe Lieberman (Ind-CT) said he would filibuster the public option but would vote for the ACA without it.
  - saghm 2mo ago
    Whoops, good correction, I did misremember public option versus single-payer, and I guess technically Liberman was not a Democrat at that point, but he had been for a while up until shortly before then and still had committee chair positions from the Democrat leadership, so it mostly feels like a distinction without a difference. I still think this is an important historical detail that seems to go under the radar a lot; if anything, it gives me yet another reason to disdain the filibuster!
czgov 2mo ago
George Bush Sr. made a deal with Democrats to raise taxes and cut spending. Ever since then the Republican strategy has been to oppose pretty much anything a Democratic President proposes. The ACA was a Republican healthcare idea and they didn’t support it because a Democrat proposed it. There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think. If it gets implemented quickly enough then getting rid of it will be very difficult to do. People won’t give up free at the point of usage healthcare once they try it out.
- saghm 2mo ago
  > There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think. It's worth keeping in mind that Eisonhower's cabinet argued against the idea of giving the polio vaccine away for free on the basis of it being a "backdoor to socialized medicine". We're over seven decades past the point where it makes sense to give a shit about what anyone says about "socialized medicine".
  - czgov 2mo ago
    Would that Obama, Jeffries, Schumer, and others felt the same way!
    - saghm 2mo ago
      For what it's worth, Obama did actually initially consider a public option[0]; it was Congress who made it clear that they wouldn't pass it that caused him to pivot to what we have now. [0]: edited from "single-payer" to reflect correction to a similar comment I made elsewhere in this thread
dominotw 2mo ago
can someone tell me this. Right now level of care is rationed by type of insurance you can afford. eg: northwestern in chicago downtown is inaccesible to ppl below certain income level. In universal everyone has access to every hospital ? Why would someone go to lower level hospital if they can go to northwestern. Now the acess to best hosptials is gated by a queue? I am not saying this is right but ppl who already have access to northwestern its in their best selfish interst to oppose universal? i am just countering the point that "ppl opposing it are merely brainwashed by foxnews or are stupid" . Its no different than ppl preventing outsider kids from going to your school.
- saghm 2mo ago
  > Now the acess to best hosptials is gated by a queue? I mean, yes? Literally the same principle we all learned in kindergarten for how to make access to something fair. You didn't get to skip the line in lunch because your parents had a better job than someone else either.
  - dominotw 2mo ago
    right. my point is last line of my comment. most of the society doesnt operate in the way that you described.
    - saghm 2mo ago
      Most of society also doesn't require paying for indirectly via employer subsidy (driving up the cost to people who are between jobs or have money by other means). If your objection is to a system that operates differently than the rest of society, it's not clear why the hypothetical healthcare system is more of a bugbear than the very real one that doesn't resemble pretty much any other way that things get purchased. I don't really understand how you think spending time arguing against something that has very little chance of happening based on principles that ostensibly conflict with the actual version that genuinely does exist is a sign that people are not being misled by those with incentives to distract them in that way or otherwise are struggling to reason about an issue logically.
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iAMkenough 2mo ago
> If your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. Describes everything the GOP offers as “solutions.” Theirs tend to strip rights while Democrats tend to provide rights. We’re still waiting on the GOP’s “concepts of a plan” for healthcare promised on the last campaign trail.
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fitsumbelay 2mo ago
> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan So you'll never vote GOP again. And you tacitly agree with Trump's repeated claim that conservatives will stay in the minority unless they _reform_ election rules -- https://www.theguardian.com/us-news/2020/mar/30/trump-republican-party-voting-reform-coronavirus https://www.theguardian.com/us-news/2020/mar/30/trump-republ.... Vote suppression and the "perpetual majority control of legislative, executive, and judicial branches," is Republican stated aim since the late 60s/early 70s when their party began its creep into permanent minority status > It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to What does this even mean? ACA was based on a GOP-governor-in-a-blue-state's successful implementation of HCR. Everyone loved it until Obama loved it, then the highly organized GOP minority hated it, fight it, wasted ~20 years claiming insanely to have a better solution they knew they never had nor will have Back when Nancy's daughter Alexandra Pelosi used to make mini-doc shorts for the intolerable Bill Maher she made one about southern white Americans' opposition to ACA. She interviewed one fellow -- perpetually unemployed, alcohol/drug/legal problems etc -- who came well out of his chest against Democrats, socialism, The Gubmint and all the other typical lefty stuff that Fox News mentors him and so many others on. Then we find out he's on welfare. Then we find out he's on Medicare/medicaid. Pelosi's like "What?? Wait a minute ... I thought you didn't like this government stuff. Why're you all over it" and mans goes "WELL I DESERVE IT!!!" Let's just call anti-UHC arguments what they are: wet bullshit from private healthcare industry stakeholders and the uninformed partisans who repeat Trumpist mantras
dualvariable 2mo ago
> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. You mean like overturning Roe v. Wade? Can't ever happen, right?
khriss 2mo ago
> ACA was predicated on studies like this, to no avail ACA was also predicated on broad participation. As with all insurance, the bigger the pool, the lower the premium. Insurance of any kind is primarily a risk arbitrage business and fundamentally relies on the presence of low risk consumers. ACA was designed with this in mind and made participation in the insurance pool mandatory(whether via the public marketplace, or via private). Unfortunately for the ACA, the individual mandate was removed in 2017 via Trump's Tax Cuts and Jobs Act, which reduced the penalty to $0, while leaving intact the ban on denials based on preexisting conditions(on it's own a good thing). The elimination of the federal tax penalty caused health insurance premiums on the ACA individual marketplace to increase by an estimated 10% annually, as younger and healthier individuals dropped coverage and left behind a sicker, more expensive risk pool. So, while it's fair to criticize the ACA, you simply can't expect a law to work if it's intentionally altered to engineer the worst case scenario specifically. Here's the overall timeline * March 23, 2010: President Barack Obama signs the ACA into law, establishing the individual mandate and its future financial penalties. * June 28, 2012: The Supreme Court upholds the individual mandate's financial penalty, ruling it a valid exercise of Congress’s taxing power. December 22, 2017: The TCJA sets the individual mandate penalty to $0. Lawmakers attached the repeal to a major federal tax overhaul package and used the budget reconciliation process that allowed the Senate to pass the measure with a simple majority vote, avoiding a filibuster. January 1, 2019: The tax penalty officially drops to $0 nationwide, effectively eliminating the financial pressure to participate.
jimt1234 2mo ago
My favorite part of the ACA is that the nickname, Obamacare, was created by Republicans, thinking it would fail and the nickname would make that failure stick to Obama better. Problem was, the ACA helped a lot of people, particularly people in red areas. So, then Republicans started complaining that Obama and the Democrats were being arrogant for putting Obama's name on the ACA.
- Helloworldboy 2mo ago
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- thiht 2mo ago
  There's been tons of short interviews showing MAGA people having no idea ACA and Obamacare were the same things. They cheered when Obamacare got repelled even though they were beneficiaries of it. MAGA propaganda is powerful
JKCalhoun 2mo ago
> …if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I suspect Social Security would have met that definition at one point in time. Perhaps even paid overtime, the 40-hour work-week, etc.
- Refreeze5224 2mo ago
  Sort of. They were not campaign slogans though. They were battle cries, by militant labor, insisting on what they deserved.
autoexec 2mo ago
> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. At this point it says more about the state of our democracy than it does about any proposed solution. Even policies widely supported by the American public these days are met with obstructionists who care less about the welfare of the country than they do about scoring and blocking political "points".
lovich 2mo ago
I would never have had healthcare as an adult without the ACA due to an illness as a child that was expensive enough that I’m sure some insurance exec was only able to get a 26 foot yacht instead of a 30 footer. It was a great success for people in my boat(no pun intended)
tootie 2mo ago
It seems far more plausible to do this at state levels. NY teased it recently and then backed off.

deleted 2mo ago

[deleted]

_heimdall 2mo ago

These types of studies, and the goals they aim to support, always frustrate me as solving a surface-level problem rather than root cause. The problem with US healthcare isn't who pays for it, its how damn expensive it is. As always there are multiple factors at play, my list would include corruption, lack of legal accountability/responsibility, and a population that is much less healthy than reasonable. Go after any one of those and we'd make a lot more headway than trying to ram through a universal, government-run healthcare or insurance program. And yes, such a program could impact the above topics, but it doesn't have to and could make any of them worse.

loeg 2mo ago
Americans just consume a lot of healthcare services. Any substantial cost savings requires providing less healthcare service.
- quacked 2mo ago
  That's not necessarily true; fewer limitations on who is allowed to provide health service and manufacture medicine and health technologies would also drop prices. Competition in healthcare is very, very difficult because it's often illegal to compete.
  - whimsicalism 2mo ago
    You're actually talking about the same problem. Competition in healthcare is heavily restricted by stuff like certificates of need because there is little cost-sharing with utilizers so you get overutilization & induced demand. This is Roemer's law [0]. A large part of the reason for competition restrictions is because of a hacky attempt to control overutilization without direct cost-sharing. 0: https://en.wikipedia.org/wiki/Roemer%27s_law https://en.wikipedia.org/wiki/Roemer%27s_law
- t-writescode 2mo ago
  Citation needed (per capita please). Given that people constantly, literally AVOID care because they can’t pay for it until it’s such an absurd problem that it’s very, very expensive, I struggle to believe this, at all. And money amount doesn’t matter in this evidence because, again, Americans regularly avoid care until it’s catastrophic because they literally can’t afford it and/or have to wait for insurance to meet a certain harm level threshold where it literally can no longer be argued (emergency care)
  - SoftTalker 2mo ago
    I think a citation is needed for "Americans regularly avoid care ... because they can’t afford it." I think there are other reasons, e.g. they don't like doctors, or it's too inconvenient, or waiting times are too long. I have good insurance and haven't seen a doctor in probably 20 years. I know people who are visiting the doctor for every sore throat, ache and pain or sneeze and sniffle, and that's not me at all.
    - TimorousBestie 2mo ago
      Here you go, a recent survey: https://www.jgwentworth.com/resources/medical-emergency https://www.jgwentworth.com/resources/medical-emergency > The survey showed that over nine in ten (92%) of insured respondents had delayed or avoided medical care because of concern about cost. > In fact, 95% of those surveyed said a medical emergency would likely put them into serious debt even with insurance.
      - SoftTalker 2mo ago
        An unexpected car replacement would put most people into serious debt. And there's no insurance for that. People get so hung up on the idea that they should have to pay for health care, when you have to pay for every other necessity in life.
        TimorousBestie 2mo ago
        So you didn’t want a citation after all. Alas.
- dboreham 2mo ago
  In some cases they are provided healthcare services without a choice, so they're not really "consuming" those services. E.g. tests that don't change outcome but do cover a provider from a legal risk.
- nradov 2mo ago
  Something like 20% of healthcare services are "low value care" which aren't justified by evidence-based medicine criteria and may even harm the patient. Regardless of the financing system we could free up a lot of capacity and slash costs by eliminating that low value care. Of course in practice it's difficult to do that at scale. https://www.bloomsbury.com/us/price-we-pay-9781635575910/ https://www.bloomsbury.com/us/price-we-pay-9781635575910/
hx8 2mo ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is Saving $1,000,000,000,000/yr is directly addressing how damn expensive it is.
- _heimdall 2mo ago
  (1) we don't know the claims of the study will be accurate if implemented and (2) we would need studies modelling cost savings of alternative approaches to actually compare anything. Obamacare made wild claims about cost savings as well. That didn't work out for many reasons that could show up again with another universal healthcare push.
  - hx8 2mo ago
    1. Do any of the cost savings recommendations you address come close to $1T/yr impact? This is the scale we should be aiming for. 2. If you think this modeling is inaccurate or incomplete you can directly discuss that. That would be a much more interesting discussion than "it might be incorrect."
    - _heimdall 2mo ago
      That's a great question, and one that should receive similar funding and attention to properly compare. My hunch is that (a) this study over estimates on the cost reduction side and would not pan out, and (b) improving health should always be a better cost savings than reducing corporate overhead (especially given how piss poor our average health is today).
  - dmschulman 2mo ago
    There's a multitude of evidence that points to the success of the ACA from a cost perspective (among other things). Cost of healthcare for individuals is not a good metric to judge by. The ecosystem of hospitals, patients, doctors, insurers, health systems, and the federal government is complex and you're not going to get a clear picture of the overall impact of the ACA by looking as something as simple as cost savings. One example, hospitals are required to treat patients whether or not they hold insurance. The hospital foots the bill for that care and it's a major reason why hospitals shut down (especially in underserved communities). Getting more people on insurance plans was a direct factor is keeping many struggling hospitals and health systems afloat. https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/ https://www.statnews.com/2019/03/22/affordable-care-act-cont... https://www.networkforphl.org/news-insights/the-affordable-care-act-reflections-on-10-years/ https://www.networkforphl.org/news-insights/the-affordable-c... https://www.cbpp.org/research/health/chart-book-accomplishments-of-affordable-care-act https://www.cbpp.org/research/health/chart-book-accomplishme...
nsxwolf 2mo ago
We never attempted to solve the issue of distorted price signals that occur when customers aren't the ones paying for something. We're still charging $600 for a bag of saline.
- jtbayly 2mo ago
  Especially when the buyer and seller are the same huge monopoly entity, but the payer is “somebody else,” the incentives are completely perverse.
Retric 2mo ago
No, it’s not a question of who pays for it but who benefits. You could have universal health with zero additional spending by the US government, but all that administrative overhead is someone’s income.
- QuercusMax 2mo ago
  Companies don't hesitate to lay people off when their jobs aren't needed. I don't see why these parasitic insurance companies need to stay in business.
- _heimdall 2mo ago
  No one benefits when there's a single player in an industry. When that single player also owns your taxes and military, its a risk we should at least avoid if at all possible.
  - Retric 2mo ago
    Let’s try and deal with actual facts here. If you disagree then you should be able to post some actual data in terms of lifespans or costs that says otherwise. There’s multiple healthcare systems around the world, single payer results in vastly less administrative and thus overall spending and equal or better outcomes overall. So by objective criteria the average person massively benefits from single payer healthcare.
hnlmorg 2mo ago
The point of nationalisation is to address those underlying concerns. But it’s fair to say that in practice, nationalisation doesn’t always solve those problems. The problem is you either need to regular or nationalise. And neither of those are particularly “American”.
- _heimdall 2mo ago
  I don't think our problem is a lack of regulation though. If anything its a lack of market competition, and that is caused by over regulation and legal protections that make holding companies responsible difficult or impossible.
  - mindslight 2mo ago
    It's also caused by absurd nonsense like how doctors can't tell you how much anything they're proposing to do actually will cost (a necessary condition for entering into a contract!), but then the system makes up arbitrary bills after the fact - with fraudulent amounts that nobody actually pays! No other industry works like that, as it's not the foundation of a market in the first place. Imagine if going to the grocery store involved "paying" some token amount at the cashier for their time to put your items in bags, then for the food you received shakedown bills for years afterwards, that you had to spend time going through your old documentation to refute and bargain down. Absurd. Regardless of "insurance", who is ultimately paying, or subsidies to provide a baseline of care - there needs to be reform that mandates simple up-front prices, constant per-provider regardless who is paying, and ruling out any other theory of billing. Doctors throw up their hands and act like they're dealing with some special problems, but there are plenty of other industries we can look at for the dynamics of how to handle routine procedures versus emergencies (and knowns vs unknowns) in a consensual and market-responsive manner.
    - nradov 2mo ago
      That's all true, but from a practical standpoint providers really have no way to accurately estimate a patient's out-of-pocket financial responsibility in advance. The current HIPAA adopted standard transactions don't allow for sending a prospective claim. So all they can realistically do is perform the procedure, submit a claim to the patient's health plan, wait for it to (maybe) be paid, and then send a bill to the patient for the balance. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct... The good news is that CMS is working on an update to those standards which will at least make prospective claims technically possible. Although it may take years until that functionality is widely implemented.
giantg2 2mo ago
"The problem with US healthcare isn't who pays for it, its how damn expensive it is." And also how much is required. I bet a study investigating how much money and lives could be saved by reducing obesity would have 2x numbers
- _heimdall 2mo ago
  Exactly. I'd at least want to see similarly funded studies comparing solves for underlying causes beyond just insurance companies not being nationalized. Similarly we could look into the likely cost of over medicating our people, and the atrocities we call food in grocery stores.
larkost 2mo ago
I agree that this proposal would not solve all of the problems; absent more changes you would still see the creep up of healthcare costs at too high a rate. But slashing $1 trillion off of a $5.3 trillion costs is a pretty big bite of the apple. Even if you go with the more conservative $663 number, that is still a great first step. And both of those numbers are after adding the costs of covering currency uncovered people. So we are collectively getting more for significantly less money. It does this by eliminating a very inefficient layer of our current system (insurance companies), and by having there replacement for that (the government) negotiate on drug prices (how much savings there is the reason there are two estimates). Currently insurance companies almost have a negative incentive to push down drug prices (their profits are limited to a percentage of total spending, and most large companies are pushing against that limit). Most of the cost control pressures in our current system come out of Medicare/Medicade, and this would widen that out to the whole system. That in turn would wedge open the door to pushing on the other drivers of the cost spirals: hospital administration, new expensive drugs that are not worth the additional costs, doctor salaries ballooning, and the broken system between malpractice insurance and dysfunctional enforcement against malpractice.
- _heimdall 2mo ago
  I understand that theres an argument for removing private insurance companies in favor of thr government can cut costs. It can also increase them. I'd argue that the primary issue with insurance costs today is the lack of market competition, obscurity of what costs and prices are, and government protections that prevent insurance companies from being legally liable for many of the problems they cause. Corruption and monopolistic practices is a big deal in healthcare, for example. We'd be better off, in my opinion, by solving that rather than killing an entire private industry and hoping our government can continue to do it better indefinitely.
  - onraglanroad 2mo ago
    >theres an argument for removing private insurance companies in favor of thr government I don't see why you'd need to do that. Just expand medicare to everyone and if people want to also buy private insurance they can. They'd just need to be more competitive and add significant value, which they don't currently do.
SpicyLemonZest 2mo ago
It's extremely challenging to go after high costs in the current system, because the doctors who charge them are popular and the insurance companies who pay them are hated. There was a 2024 story that stuck in my mind (https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue-shield-anesthesia-anthem https://www.npr.org/2024/12/05/nx-s1-5217617/blue-cross-blue...) when Anthem tried to negotiate down the rate of certain anesthesia procedures; the public was absolutely outraged, successfully demanding that Anthem must back down and accept whatever the doctors feel is the appropriate pricing model.
- _heimdall 2mo ago
  The disconnect between prices and end consumers is itself a huge problem. I should know what care costs before I get it, and I should know how much my instance company is paying on my behalf before I get care. For prices to be sane we need people being able to compare prices, decide what care they want and can afford, etc. Our prices are so high because its a closed market acting as though it were a free/open market being driven in part by customer decisions.
  - SpicyLemonZest 2mo ago
    I think that’s a reasonable model to want, but it’s what we call “preauthorization”, and many patients along with most doctors absolutely hate it. In order to know with certainty what your care will cost and how much your insurance company will pay, the doctor has to contact them in between deciding what treatment you should have and giving you the treatment. You can and I do solve that annoyance with an HMO, where the doctors and insurance can communicate more effectively because they’re part of the same organization. But that also means it’s difficult or impossible for me to get the kind of care that a normal insurance company would hesitate to approve.
    - _heimdall 2mo ago
      Preauthorization is a bit different, and yes I can see care providers hating it. Its possible for a provider to know ahead of time that providing a saline IV costs $60, for example. Its also possible to have health care policies that approve any treatment deemed necessary at any healthcare provider, or at any healthcare provider in network if that concept was still a thing. We don't have to have a preauthorisation step where doctors are expected to ask insurance companies if they will approve a certain treatment for a certain patient before it can be done. That is a particularly terrible implementation if you ask me.
bcrosby95 2mo ago
I have a strong dislike for the industry as a whole. There's too many ridiculous situations I've been subject to, along with hearing of some from my friends. My favorite was a friend who had to deliver her baby, alone, in a hallway, because they forgot about her. And the hospital billed her for it. LOL.
hintymad 2mo ago
> The problem with US healthcare isn't who pays for it, its how damn expensive it is Exactly! There's so much paperwork that a doctor sometimes need two assistants just for the paper work. There's so much cost for independent practice that increasingly more doctors end up joining big hospitals. Charges with and without insurance have a huge difference. Just to name a few.
- autoexec 2mo ago
  Universal healthcare would cut down on the paperwork needed and provide opportunities to simplify it
- HDThoreaun 2mo ago
  medicare is basically the biggest culprit for the "too much paperwork" stuff. A m4a plan that doesnt involve capitation would have even more paperwork than the current system does.
tptacek 2mo ago
This paper is based on numbers from the CMS NHE. Here are those numbers summarized (up to 2023): https://nationalhealthspending.org/ https://nationalhealthspending.org/ I haven't finished reading the paper and have no opinions on it (other than that most successful universal systems aren't single-payer) but if we start from actual numbers the discussion will be better.

Tepix 2mo ago

> if your solution requires perpetual majority control I think once universal health coverage is established, it amounts to political suicide to try to take it away again.

TimorousBestie 2mo ago
I don’t think “political suicide” exists anymore.
- shigawire 2mo ago
  We still have Social Security for now. Entitlements are sticky for better or for worse.
  - warkdarrior 2mo ago
    Social Security in its current form will be gone within two years. Instead you will be required to pay a contribution (just as you are now) but the money will be managed by a private company who will charge fees and provide no guarantees. Current retirees will get to keep the current arrangement, everyone else will be moved to the privately managed Social Security option.
    - xboxnolifes 2mo ago
      Is this based on something real happening within 2 years, or just a continuation of the 30 year sentiment that social security will be gone before my generation will get access to it?
    - AstralSerenity 2mo ago
      People have been saying this forever. It will never happen. Republicans and Democrats alike love Social Security. All that needs to be done to fix it is raise the cap.
- cogman10 2mo ago
  We still have Medicare, Medicaid, and social security. Even though each program has been weakened, none of them have been abolished and they can all be restored. Heck, we still have SNAP, even though it's almost universally hated by republicans.

mapt 2mo ago

"If your solution requires addressing the slow-burn civil war, your solution is just a campaign slogan". Essentially, all solutions require addressing the slow-burn civil war, which is today capable of of subsuming any issue. Not a single policy issue can realistically be addressed while the rabid 800lb gorilla is in the room. That gorilla is not Trump, that gorilla is Heritage, Fox News, Koch, et al.

epistasis 2mo ago

ACA has saved tons of lives. Due to the intense opposition, it was not structured in a way that could save money, but rather structured in the way that it could get through congress. Additionally, as somebody who was around pre-ACA, I can not tell you how much better, in every single way, the post-ACA healthcare world is. Pre-existing conditions? Access to healthcare as an individual? These are life-changing possibilities, especially for entrepreneurs. There's a very clear type of fallacy you are engaging in here that only works in politics: you're taking a vague general idea X, ignoring all particulars, and then lumping an idea Y together as if they identical and that any change in that general direction of Y could ever be different than what happened with X. There's no intellectual rigor or honesty in that sort of thinking, yet it somehow pops up throughout all of politics.

strictnein 2mo ago
> ACA has saved tons of lives It was the Medicaid expansion that has been cited as saving lives [0]. An expansion that has almost nothing to do with the rest of the ACA. > "There's a very clear type of fallacy you are engaging ... There's no intellectual rigor or honesty in that sort of thinking" So you're claiming that the person who posted that is not only falling into a fallacy, but they are neither intellectually rigorous or honest? I think you're reading a lot into their comment which seemed pretty benign, but possibly contrary to your viewpoint? [0] https://news.uchicago.edu/story/new-research-shows-medicaid-expansion-reduced-mortality-low-income-adults https://news.uchicago.edu/story/new-research-shows-medicaid-...
- epistasis 2mo ago
  > An expansion that has almost nothing to do with the rest of the ACA. That's a very strange assertion, it's literally "the ACA medicaid expansion" and was a key part of the whole thing. I'm saying most political argumentation is dishonest and not intellectually rigorous, and that's what the comment was doing. It wasn't arguing based on facts or data or actual specifics, but rather according to vague political ideologies. That's one reason that I believe politics are discouraged on HN. It turns off our brains and we start using less interesting or useful ways of thinking.

saulpw 2mo ago

ACA is not Universal Health Coverage. So this would be different enough. And you don't need perpetual majority control, only sensible politicians for about a generation (like FDR/Truman/Eisenhower/JFK) to lock in a popular entitlement.

apothegm 2mo ago
Sensible politicians? In the US? In this era? For a _generation_???
- saulpw 2mo ago
  I agree it would be very difficult, but still a lot easier than 'perpetual'.
strictnein 2mo ago
FDR and "sensible" is always funny to me. The sensible politician that imprisoned Japanese Americans, destroying the lives of 120,000 of our fellow citizens.
robertoandred 2mo ago
It was pretty close until republicans pulled back Medicaid.

boutell 2mo ago

This is exactly the argument that gave us the Affordable Care Act. It was literally a republican plan from Massachusetts. It was supposed to be broadly acceptable and that's why it was implemented with a billion compromises. But the Republicans called the Democrats commies anyway and refused to participate. And that has been their playbook ever since. That is what they are going to do, no matter what we propose. So we may as well propose actual universal healthcare. But I agree with you that we need to create strong majorities to keep it in place until it reaches the kind of momentum it has in Canada or Sweden and opposition to it becomes a practical impossibility, like opposing social security. Maybe someday we can have a system where losing health insurance isn't a motivation for not starting a company. Our current system is a complete disaster for entrepreneurial capitalism.

saghm 2mo ago
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lvl155 2mo ago

You mean obstacles from politicians who took money from the healthcare industry. That’s how we ended up with PPACA and they used it to justify massive cost increases and consolidations. They passed that junk to save face and now healthcare is far worse. But we “closed” the donut hole, right? Quite literally made everyone worse off and no one wants to talk about it. I still can’t believe they allowed payors such as UNH to buy up everything without ANY proper investigations during that period.

deleted 2mo ago

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saghm 2mo ago

I mean, the original plan for what became ACA was single payer. They didn't have the votes from the moderate democrats though, which is why the "private plans on public exchanges" became a thing instead. You're not wrong at at least for the forseeable future, single payer does seem untenable politically, but I'd argue that dismissing studies like this on the basis that it needs solved before debating it on its merits is circular, because the only plausible political objection to a policy like this is financial. If you reflexively claim that nothing without broad consensus appeal at a given point in time is worth discussing, you're essentially arguing in favor of freezing our public policy to whatever the current public opinion is today. I don't think you need to go very far back in history to see some pretty striking examples of why that would be undesirable.

while_true_ 2mo ago
They had 59 votes from Democrats for the public option, not single payer. Public option is to let people choose either a non-profit government insurance plan or private insurers. They needed 60 votes to break a Republican filibuster. Joe Lieberman (Ind-CT) said he would filibuster the public option but would vote for the ACA without it.
- saghm 2mo ago
  Whoops, good correction, I did misremember public option versus single-payer, and I guess technically Liberman was not a Democrat at that point, but he had been for a while up until shortly before then and still had committee chair positions from the Democrat leadership, so it mostly feels like a distinction without a difference. I still think this is an important historical detail that seems to go under the radar a lot; if anything, it gives me yet another reason to disdain the filibuster!

czgov 2mo ago

George Bush Sr. made a deal with Democrats to raise taxes and cut spending. Ever since then the Republican strategy has been to oppose pretty much anything a Democratic President proposes. The ACA was a Republican healthcare idea and they didn’t support it because a Democrat proposed it. There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think. If it gets implemented quickly enough then getting rid of it will be very difficult to do. People won’t give up free at the point of usage healthcare once they try it out.

saghm 2mo ago
> There are only two realistic possibilities. Get a Republican to propose some sort of national healthcare or have Democrats fully embrace socialized medicine and not give a shit what Republicans say or think. It's worth keeping in mind that Eisonhower's cabinet argued against the idea of giving the polio vaccine away for free on the basis of it being a "backdoor to socialized medicine". We're over seven decades past the point where it makes sense to give a shit about what anyone says about "socialized medicine".
- czgov 2mo ago
  Would that Obama, Jeffries, Schumer, and others felt the same way!
  - saghm 2mo ago
    For what it's worth, Obama did actually initially consider a public option[0]; it was Congress who made it clear that they wouldn't pass it that caused him to pivot to what we have now. [0]: edited from "single-payer" to reflect correction to a similar comment I made elsewhere in this thread

dominotw 2mo ago

can someone tell me this. Right now level of care is rationed by type of insurance you can afford. eg: northwestern in chicago downtown is inaccesible to ppl below certain income level. In universal everyone has access to every hospital ? Why would someone go to lower level hospital if they can go to northwestern. Now the acess to best hosptials is gated by a queue? I am not saying this is right but ppl who already have access to northwestern its in their best selfish interst to oppose universal? i am just countering the point that "ppl opposing it are merely brainwashed by foxnews or are stupid" . Its no different than ppl preventing outsider kids from going to your school.

saghm 2mo ago
> Now the acess to best hosptials is gated by a queue? I mean, yes? Literally the same principle we all learned in kindergarten for how to make access to something fair. You didn't get to skip the line in lunch because your parents had a better job than someone else either.
- dominotw 2mo ago
  right. my point is last line of my comment. most of the society doesnt operate in the way that you described.
  - saghm 2mo ago
    Most of society also doesn't require paying for indirectly via employer subsidy (driving up the cost to people who are between jobs or have money by other means). If your objection is to a system that operates differently than the rest of society, it's not clear why the hypothetical healthcare system is more of a bugbear than the very real one that doesn't resemble pretty much any other way that things get purchased. I don't really understand how you think spending time arguing against something that has very little chance of happening based on principles that ostensibly conflict with the actual version that genuinely does exist is a sign that people are not being misled by those with incentives to distract them in that way or otherwise are struggling to reason about an issue logically.

deleted 2mo ago

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iAMkenough 2mo ago

> If your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. Describes everything the GOP offers as “solutions.” Theirs tend to strip rights while Democrats tend to provide rights. We’re still waiting on the GOP’s “concepts of a plan” for healthcare promised on the last campaign trail.

deleted 2mo ago

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fitsumbelay 2mo ago

> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan So you'll never vote GOP again. And you tacitly agree with Trump's repeated claim that conservatives will stay in the minority unless they _reform_ election rules -- https://www.theguardian.com/us-news/2020/mar/30/trump-republican-party-voting-reform-coronavirus https://www.theguardian.com/us-news/2020/mar/30/trump-republ.... Vote suppression and the "perpetual majority control of legislative, executive, and judicial branches," is Republican stated aim since the late 60s/early 70s when their party began its creep into permanent minority status > It has to be different enough that those who would oppose it right after the inevitable pendulum swing do not want to What does this even mean? ACA was based on a GOP-governor-in-a-blue-state's successful implementation of HCR. Everyone loved it until Obama loved it, then the highly organized GOP minority hated it, fight it, wasted ~20 years claiming insanely to have a better solution they knew they never had nor will have Back when Nancy's daughter Alexandra Pelosi used to make mini-doc shorts for the intolerable Bill Maher she made one about southern white Americans' opposition to ACA. She interviewed one fellow -- perpetually unemployed, alcohol/drug/legal problems etc -- who came well out of his chest against Democrats, socialism, The Gubmint and all the other typical lefty stuff that Fox News mentors him and so many others on. Then we find out he's on welfare. Then we find out he's on Medicare/medicaid. Pelosi's like "What?? Wait a minute ... I thought you didn't like this government stuff. Why're you all over it" and mans goes "WELL I DESERVE IT!!!" Let's just call anti-UHC arguments what they are: wet bullshit from private healthcare industry stakeholders and the uninformed partisans who repeat Trumpist mantras

dualvariable 2mo ago

> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. You mean like overturning Roe v. Wade? Can't ever happen, right?

khriss 2mo ago

> ACA was predicated on studies like this, to no avail ACA was also predicated on broad participation. As with all insurance, the bigger the pool, the lower the premium. Insurance of any kind is primarily a risk arbitrage business and fundamentally relies on the presence of low risk consumers. ACA was designed with this in mind and made participation in the insurance pool mandatory(whether via the public marketplace, or via private). Unfortunately for the ACA, the individual mandate was removed in 2017 via Trump's Tax Cuts and Jobs Act, which reduced the penalty to $0, while leaving intact the ban on denials based on preexisting conditions(on it's own a good thing). The elimination of the federal tax penalty caused health insurance premiums on the ACA individual marketplace to increase by an estimated 10% annually, as younger and healthier individuals dropped coverage and left behind a sicker, more expensive risk pool. So, while it's fair to criticize the ACA, you simply can't expect a law to work if it's intentionally altered to engineer the worst case scenario specifically. Here's the overall timeline * March 23, 2010: President Barack Obama signs the ACA into law, establishing the individual mandate and its future financial penalties. * June 28, 2012: The Supreme Court upholds the individual mandate's financial penalty, ruling it a valid exercise of Congress’s taxing power. December 22, 2017: The TCJA sets the individual mandate penalty to $0. Lawmakers attached the repeal to a major federal tax overhaul package and used the budget reconciliation process that allowed the Senate to pass the measure with a simple majority vote, avoiding a filibuster. January 1, 2019: The tax penalty officially drops to $0 nationwide, effectively eliminating the financial pressure to participate.

jimt1234 2mo ago

My favorite part of the ACA is that the nickname, Obamacare, was created by Republicans, thinking it would fail and the nickname would make that failure stick to Obama better. Problem was, the ACA helped a lot of people, particularly people in red areas. So, then Republicans started complaining that Obama and the Democrats were being arrogant for putting Obama's name on the ACA.

Helloworldboy 2mo ago
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thiht 2mo ago
There's been tons of short interviews showing MAGA people having no idea ACA and Obamacare were the same things. They cheered when Obamacare got repelled even though they were beneficiaries of it. MAGA propaganda is powerful

JKCalhoun 2mo ago

> …if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. I suspect Social Security would have met that definition at one point in time. Perhaps even paid overtime, the 40-hour work-week, etc.

Refreeze5224 2mo ago
Sort of. They were not campaign slogans though. They were battle cries, by militant labor, insisting on what they deserved.

autoexec 2mo ago

> I'm of the opinion that, if your solution requires perpetual majority control of legislative, executive, and judicial branches, your solution is in fact a campaign slogan. At this point it says more about the state of our democracy than it does about any proposed solution. Even policies widely supported by the American public these days are met with obstructionists who care less about the welfare of the country than they do about scoring and blocking political "points".

lovich 2mo ago

I would never have had healthcare as an adult without the ACA due to an illness as a child that was expensive enough that I’m sure some insurance exec was only able to get a 26 foot yacht instead of a 30 footer. It was a great success for people in my boat(no pun intended)

tootie 2mo ago

It seems far more plausible to do this at state levels. NY teased it recently and then backed off.