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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

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.
- czgov 2mo ago
  Your linked to article does not demonstrate what you claim it does. Your reasoning is wrong. Medicaid expansion was a big part of the ACA.
  - strictnein 2mo ago
    > "Findings suggest Medicaid expansion under the Affordable Care Act saved about 27,400 lives between 2010-22, including among younger adults." > "Their findings show that Medicaid expansions led to a 12% increase in enrollment and significantly reduced mortality—not just among older adults, but also younger ones, who accounted for nearly half of the life-years saved." Huh? Did you read it? My point was that we could have just expanded Medicaid to achieve this.
    - blitzar 2mo ago
      > we could have just expanded Medicaid Laws need votes. If we are going to be unbound by reality then we could "just" put a medbed to cure all diseases, reverse ageing, and regrow limbs using quantum space-age tech in everyone's home.
      - strictnein 2mo ago
        Too many people think snark is a substitute for insight. The major GOP complaint about the entire thing was that it was the federal government forcing people to buy a product from companies. The Supreme Court ruled that it had that power.
        blitzar 2mo ago
        I missed the part of your insight where the GOP would have voted to expanded Medicaid to all. If they are down for it, I can make a call and it would be a near unanimous vote.
        czgov 2mo ago
        The ACA was the Republican plan until championed by Obama. The Republican goal was to say anything to denigrate their own plan. Romney later became the nominee for President and it was his plan that the ACA was largely based off of. Republicans fought hard to discredit their own plan. They just wanted to move to the right of whatever it was that the black man championed.
- ButlerianJihad 2mo ago
  "Saved lives" or "Could Save Lives" is a ridiculous, un-falsifiable, and unprovable claim. First, it involves twisting correlation and causation into an Escher knot. Secondly, it's not even what cited source says. Yes, "reduced mortality along a timeline for a certain demographic" is a good and desirable statistic, but there is no way that it translates into the self-aggrandizing and sensationalistic "ACA/Medicaid saved tons of lives" (whatever "tons" is supposed to mean, in terms of lives. Perhaps grossly obese people died less.)
  - solid_fuel 2mo ago
    [flagged]
    - dang 2mo ago
      Yikes, can you please stop crossing into personal attack? You've been doing this repeatedly and even egregiously: https://news.ycombinator.com/item?id=49335212 https://news.ycombinator.com/item?id=49335212 https://news.ycombinator.com/item?id=49334249 https://news.ycombinator.com/item?id=49334249 https://news.ycombinator.com/item?id=49324512 https://news.ycombinator.com/item?id=49324512 https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323061 https://news.ycombinator.com/item?id=49323061 https://news.ycombinator.com/item?id=49322063 https://news.ycombinator.com/item?id=49322063 We ban accounts that won't stop doing this. I don't want to ban you since you also make good contributions. If you would please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
      - solid_fuel 2mo ago
        Alright, heard, I will be less snarky and aggressive. However, in this case - https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323758 - if HackerNews guidelines allow for someone to defend torture and call it “life affirming medical care” but don’t allow someone to wish for turnabout, then this site isn’t compatible with my worldview and you should just ban me. Because I do not intend to ignore such heinous things when I see them.
lvl155 2mo ago
Let’s be honest, it was DOA. Even Gruber admitted to it later. The whole thing was basically a scam. Edit: I will never understand why people think ACA was so great. It was a bad policy because they couldn’t get it through whole. They passed it with all the compromises that made it DOA. You can’t fix something when you are still in denial about it being bad. ACA is not a transition to universal healthcare when you allowed massive consolidation in the space with some of the biggest companies in this country. Good luck deconstructing that mess.
- lovich 2mo ago
  > I will never understand why people think ACA was so great. I would never have healthcare without it due to pre existing conditions from childhood. I literally was going to be locked out of healthcare barring becoming wealthy enough to afford everything out of pocket until it passed. And that’s really wealthy not just software engineer money. I know a lot of doctors are offering routine services for cash at a discount in increasing amounts but if you need anything with a hospital or a specialist it’s a nightmare to even find out the price before agreeing to the service.
jvanderbot 2mo ago
Keep in mind, I made no value judgement on ACA at all, just suggested that we learn about its opposition and, as you rightly point out, the difficulty of passing such legislation that can last over time. I agree that "To no avail" could be read as "was worthless" to an adversarial reader, but trust me when I say it was meant as "which didn't save it from being opposed and stripped over time". As in "the studies and facts don't move the politics" It should be obvious the messaging is oppositional along party lines. Every chip away at ACA makes it a worse program, and is celebrated by half the electorate. This is a core problem with the legislation. A second iteration on top, or in place, would have to learn from this and work to make the program stickier.
slg 2mo ago
>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. The failures and politicization of the ACA have caused us to be a little too dismissive of its successes and popularity. Protections for pre-existing conditions and allowing children to stay on family plans until 26 in particular have made an incredible difference in a lot of people's lives and are wildly popular. So much so that it would be close to political suicide to try to remove them as evidence by Republicans controlling all three branches of government including both chambers of Congress and there is no serious talk of repealing them. There is belief among a lot of its supporters that universal healthcare would have a similar wave of support if enacted and that the opposition is mostly irrational political arguments rather than people's true feelings about an actual policy. This is why the "ACA" polls higher than "Obamacare" despite those being two terms for the same legislation.
- pyronik19 2mo ago
  ACA is horrible for the middle class. The only reason it retains any type of popularity is because the media refuses to associated ballooning cost to cost redistribution that it enables. Preexisting conditions? Middle class family picking that up. Subsidy? Middle class family picking that up.
  - ComputerPerson 2mo ago
    This is unfair to the ACA and factually incorrect. ACA subsidies (median household size) [1] are designed to start above the 50th percentile (income) [2]. The details matter. If you're a single person living alone at an income of $70,000.00, you're below the median household income and "picking up" other people's subsidies, but that's not indicative of the country. [1] https://www.healthcare.gov/lower-costs/ https://www.healthcare.gov/lower-costs/ [2] https://www2.census.gov/programs-surveys/demo/tables/p60/286/tableA3.xlsx https://www2.census.gov/programs-surveys/demo/tables/p60/286...
  - nradov 2mo ago
    In a wealthy and civilized society we have a moral obligation to care for all of our citizens. Some of them have pre-existing conditions and can't afford to pay market rates, so the middle class is going to have to subsidize them one way or another. Whether that subsidy comes in the form of higher insurance premiums or higher taxes hardly matters.
jtbayly 2mo ago
I lost my individual healthcare plan, and I couldn’t afford the new ones. Remember when they said you could keep your plan? Yeah, that’s the one I lost.
- QuercusMax 2mo ago
  There was never a guarantee that you were going to keep your plan anyway, was there? Insurance companies are changing plans from year to year.
  - jtbayly 2mo ago
    The plan was cancelled because of ACA requirements. I had had it for several years prior. Yes, plans change, but this was different.
    - QuercusMax 2mo ago
      Which requirements made them cancel it? Was it a high deductible scam plan?
      - jtbayly 2mo ago
        It was a high deductible insurance plan, not a monthly subscription to all your healthcare needs. Why would you call that a “scam”? And for the record, it was not as high a deductible as most “silver” plans on the exchange currently.
        bonsai_spool 2mo ago
        > It was a high deductible insurance plan Why do you believe that the ACA would have wanted such plans cancelled? There's a very straightforward public health reason that's reminiscent of why states require drivers to have car insurance. > And for the record, it was not as high a deductible as most “silver” plans on the exchange currently. The plan would have been in effective over 18 years ago. Does your internet plan look the same now as it did 18 years ago? Your cell phone plan?
th0raway 2mo ago
No system that saves money can pass in congress: that's the real problem that we cannot actually avoid. Forget pressure from large companies: So many of US costs come from very high salaries, and a lot of bureaucratic positions that don't exist elsewhere. Every dollar we pay goes to someone, and it's not just some random mogul here or there that will be OK anyway. Reform that really lowers prices means loss of jobs, which them will be blamed on the politicians who signed the bill into law.
sys32768 2mo ago
Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened. My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib. Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough. We had an insurance rep come to my work last year who said after ACA they had some people whose premiums went up 900%. So yeah, ACA is better in your world, but not in mine.
- unnamed76ri 2mo ago
  Yep. We were promised it would save us money. Instead, healthcare care costs skyrocketed thanks to Obamacare.
- elevation 2mo ago
  Yeah, since the ACA my coverage has remained the same while my costs have risen 10x; I'm in my 30s and my medical insurance costs 3x what my mortgage costs, and I still have $$$$ sized bills after a round of strep throat. I would really like to just be able to get a true catastrophic policy which would cover unlikely risks such as cancer -- and then go on a cash basis for common meds and treatments. The ACA made this kind of insurance illegal, so my choice is to leave my family uninsured -- or let insurance soak up the money I might have saved for their college education.
- nradov 2mo ago
  Your blame is misplaced. Costs are increasing in spite of the ACA, not because of it. Pre-ACA your family insurance policy was likely worse in some key ways: it probably excluded coverage pre-existing conditions and had a lifetime maximum coverage limit.
  - missedthecue 2mo ago
    But then the blame might be correctly placed? If he had no pre-existing conditions and was on a no-existing conditions plan, that plan might have saved him a lot of money. Imagine car insurance regulations changing in such a way to force underwriters to blanket-assume everyone has had a couple speeding tickets this year. I understand why we do it. We are ok with speeders paying more for insurance, and not ok with someone born with diabetes forced to pay more for health insurance. But it is the end result in any case.
yieldcrv 2mo ago
Republicans finalized things to address medical costs and chiseling at hospital billing - regulations promulgated during Democrat regimes - so I would say there is bipartisan consensus for the actual arguments, if people listened to the actual arguments instead of seeing a no-vote as an opposite nonsensical ideology. This has been one of the opposition points - don't just give a handout to insurance companies without addressing their billing practices The original ACA did not have consensus for some of the proposals to address the billing practices such as existing and new state healthcare programs having collective bargaining. And yeah I think the original ACA was unworkable, compromise is taught as a good thing to children in this country, but it just means "the wrong answer". The tweaks now, alongside the original democrat led ACA, alongside the parts that were stripped out I think could have better consensus does need a rebranding though. The only thing that will actually lower costs in our society is healthy people. And right now, everyone is unhealthy and not doing preventative measures due to expense.
cactacea 2mo ago
> These are life-changing possibilities, especially for entrepreneurs. I would quit my day job and completely focus on my side business if I didn't have to worry about healthcare.
- etchalon 2mo ago
  I was wondering one day why it seemed like so many YouTubers were Canadian. The "well of course" moment took me a day longer than it should have.
- hombre_fatal 2mo ago
  I also think about people stuck in bad relationships they'd otherwise leave.
- toomuchtodo 2mo ago
  Part of the reason why there is no effort to fix this, to keep you a slave to a job that provides healthcare. Imagine the reduction in labor supply and increase in labor costs if healthcare did not require employment. On can, in many cases (facts intensive), bail to a developed country with healthcare if you want to realize this dream earlier than whenever the US will achieve the outcome (and your life situation supports doing so). It could potentially takes years, if not longer (~5-10 years), for the US to fix healthcare as the situation continues to degrade for those who need affordable healthcare today. https://news.ycombinator.com/item?id=47161587 https://news.ycombinator.com/item?id=47161587 (expat resources for those potentially interested) https://relocateme.substack.com https://relocateme.substack.com (a product of andrewstetsenko here, no affiliation, I just like resources that can help humans achieve their success criteria) https://healthcareinfusion.org/ https://healthcareinfusion.org/ (for healthcare workers interested in Canada, likely does not apply to many here, but please share with others who might be seeking a path) (i see this problem as a vulnerability management and exposure exercise to attempt to solve for, ymmv, no affiliation with any resources recommended)
  - tptacek 2mo ago
    That's not how this system came into being. It's a path-dependent quirk of the tax codes of the 1940s. We got into this predicament because of WW2-era wage controls (a dollar spent on health care by your employer was literally worth more than a dollar in wages). This is one major reason why most of the world's universal systems make private insurance work, and it doesn't blow up the way ours does. But I don't think employers are any happier about it than you are!
expedition32 2mo ago
The real problem with universal healthcare is that it immediately completely eradicates religious charity. Any single mom who works as a stripper can go see a doctor who doesn't have the slightest inclination to judge- you're just a number in a government database. Everyone's getting free shit no questions asked.
- edoceo 2mo ago
  Where is the problem here? Religious charity exists in places with universal healthcare.
- Telemakhos 2mo ago
  I don't know that "inclination to judge" is a necessary component of religious charity. Religious charities beyond healthcare give out a lot of "free shit no questions asked," and usually without any attempt at proselytization. Catholic hospitals are not known for turning down patients due to moral judgements. If there's a benefit to religious charity, it lies not in the "inclination to judge" but in maintaining a multiplicity of authorities. Combining everything under the government umbrella gives you a totalitarian society; a liberal democracy restrains the power of government while allowing for competing authorities in other spheres, like medicine, religion, academia, and the press. Giving the government the power to mandate or withhold medical treatment for political opponents (think Soviet "sluggish schizophrenia" as a diagnosis for removing dissidents from public life) seems more worrying than strippers getting free healthcare.
jandrewrogers 2mo ago
ACA also greatly increased costs. As an entrepreneur at the time, insurance premiums increased 25% overnight for the same plan. Many people had similar experiences. That the ACA forced a large number of people to pay a lot more for literally the same product is not a good outcome for those people. Too many people try to pretend this didn't happen.
- tptacek 2mo ago
  No it didn't. The ACA slowed cost growth, which was already skyrocketing by the time it passed.
  - jandrewrogers 2mo ago
    The sharp discontinuity in insurance costs over a single year for many people when ACA went into effect isn't explained by your dismissal.
    - tptacek 2mo ago
      All the stories I've heard about that came from people with bad insurance (for instance: insurance programs that could rescind coverage if you were diagnosed with something serious, and that functioned mostly as billing processors for routine care, which is where ~none of the expense in the system is). The ACA did effectively regulate those plans out of existence, so if you had one, and relied on it, it raised your cost. But when we talk about the ACA's impact on cost, we're always talking in a macro sense. Every program has individual winners and losers.
    - cyberax 2mo ago
      Insurance prices _dropped_ in NY after the ACA was enacted. Not "slowed down the growth" but actually dropped in absolute numbers. That's because NY had enacted a coverage mandate even before the ACA, so insurance companies were forced to offer policies to everyone. This resulted in a runaway spiral where only sick people were getting insurance. The ACA forced all large employers to buy insurance, greatly increasing the risk pool.
  - 2mo ago
tptacek 2mo ago
I agree with you about the ACA (as an opponent of single-payer). Prior to the ACA, members of my immediate family were uninsurable on the individual market --- not insurable at a higher rate, not insurable with exclusions, but literally uninsurable: their only options were employer-provided group coverage or state catastrophic safety net coverage programs. The twist: neither has any chronic health conditions. The underwriting refusals were based on symptoms reported in previous engagements with the health care system.
Pragmata 2mo ago
>ACA has saved tons of lives. The ACA has killed a whole lot more lives than it has saved by causing healthcare costs to spiral up. If you begin with something that is obviously incorrect and trivially debunkable, perhaps that's indication that you should review your priors.
jonhohle 2mo ago
Before I went indie, prior to ACA requirements I researched private insurance and found plans for around $3K. This year I’ll pay over $20K for a bronze plan for my family. 700% increase in less than a decade. Aetna left the marketplace input state and no pediatrician in a 10 mile radius takes the most cost effective ACA plan. The pediatricians we found are actually just GPs who have training in pediatric medicine, but we bring in the only minors they see. This is in a top-5 market based on population. All of the providers have consolidated. I don’t know if ACA affected that or not, but wait times for checkups went from later this afternoon to sometime 6 months from now. Part of my experience is going from corporate health insurance to marketplace, but in the past 5 years, ACA plans have consistently gotten worse and more expensive while service for those plans has gotten significantly worse in almost every way. Who is it better for?
- lotsofpulp 2mo ago
  ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. You are paying more because a lot more healthcare is being delivered, to people who never used to either due to exceeding maximum benefits (we have the opposite today with out of pocket maximum), or being denied for pre existing health conditions. So to answer: >Who is it better for? My 4 year old, who has received hundreds of thousands of dollars of cancer treatment, and will need a bunch more over the coming years.
  - pyronik19 2mo ago
    [dead]
  - jonhohle 2mo ago
    > ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. Then turn it into a tax and be done with it. I don't shop for my tax collector and I don't pay taxes to companies with the biggest buildings in the city. Companies that don't actually provide health care, but just collect their pound of flesh from patients and providers, driving up costs for everyone. I'm glad your child has received care. I'm very much behind the idea that pre-existing conditions should not preclude anything from receiving _care_. I'm completely opposed to mandating a private 3ᴿᴰ party be between me and my provider.

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.
czgov 2mo ago
Your linked to article does not demonstrate what you claim it does. Your reasoning is wrong. Medicaid expansion was a big part of the ACA.
- strictnein 2mo ago
  > "Findings suggest Medicaid expansion under the Affordable Care Act saved about 27,400 lives between 2010-22, including among younger adults." > "Their findings show that Medicaid expansions led to a 12% increase in enrollment and significantly reduced mortality—not just among older adults, but also younger ones, who accounted for nearly half of the life-years saved." Huh? Did you read it? My point was that we could have just expanded Medicaid to achieve this.
  - blitzar 2mo ago
    > we could have just expanded Medicaid Laws need votes. If we are going to be unbound by reality then we could "just" put a medbed to cure all diseases, reverse ageing, and regrow limbs using quantum space-age tech in everyone's home.
    - strictnein 2mo ago
      Too many people think snark is a substitute for insight. The major GOP complaint about the entire thing was that it was the federal government forcing people to buy a product from companies. The Supreme Court ruled that it had that power.
      - blitzar 2mo ago
        I missed the part of your insight where the GOP would have voted to expanded Medicaid to all. If they are down for it, I can make a call and it would be a near unanimous vote.
      - czgov 2mo ago
        The ACA was the Republican plan until championed by Obama. The Republican goal was to say anything to denigrate their own plan. Romney later became the nominee for President and it was his plan that the ACA was largely based off of. Republicans fought hard to discredit their own plan. They just wanted to move to the right of whatever it was that the black man championed.
ButlerianJihad 2mo ago
"Saved lives" or "Could Save Lives" is a ridiculous, un-falsifiable, and unprovable claim. First, it involves twisting correlation and causation into an Escher knot. Secondly, it's not even what cited source says. Yes, "reduced mortality along a timeline for a certain demographic" is a good and desirable statistic, but there is no way that it translates into the self-aggrandizing and sensationalistic "ACA/Medicaid saved tons of lives" (whatever "tons" is supposed to mean, in terms of lives. Perhaps grossly obese people died less.)
- solid_fuel 2mo ago
  [flagged]
  - dang 2mo ago
    Yikes, can you please stop crossing into personal attack? You've been doing this repeatedly and even egregiously: https://news.ycombinator.com/item?id=49335212 https://news.ycombinator.com/item?id=49335212 https://news.ycombinator.com/item?id=49334249 https://news.ycombinator.com/item?id=49334249 https://news.ycombinator.com/item?id=49324512 https://news.ycombinator.com/item?id=49324512 https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323061 https://news.ycombinator.com/item?id=49323061 https://news.ycombinator.com/item?id=49322063 https://news.ycombinator.com/item?id=49322063 We ban accounts that won't stop doing this. I don't want to ban you since you also make good contributions. If you would please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.
    - solid_fuel 2mo ago
      Alright, heard, I will be less snarky and aggressive. However, in this case - https://news.ycombinator.com/item?id=49323758 https://news.ycombinator.com/item?id=49323758 - if HackerNews guidelines allow for someone to defend torture and call it “life affirming medical care” but don’t allow someone to wish for turnabout, then this site isn’t compatible with my worldview and you should just ban me. Because I do not intend to ignore such heinous things when I see them.

lvl155 2mo ago

Let’s be honest, it was DOA. Even Gruber admitted to it later. The whole thing was basically a scam. Edit: I will never understand why people think ACA was so great. It was a bad policy because they couldn’t get it through whole. They passed it with all the compromises that made it DOA. You can’t fix something when you are still in denial about it being bad. ACA is not a transition to universal healthcare when you allowed massive consolidation in the space with some of the biggest companies in this country. Good luck deconstructing that mess.

lovich 2mo ago
> I will never understand why people think ACA was so great. I would never have healthcare without it due to pre existing conditions from childhood. I literally was going to be locked out of healthcare barring becoming wealthy enough to afford everything out of pocket until it passed. And that’s really wealthy not just software engineer money. I know a lot of doctors are offering routine services for cash at a discount in increasing amounts but if you need anything with a hospital or a specialist it’s a nightmare to even find out the price before agreeing to the service.

jvanderbot 2mo ago

Keep in mind, I made no value judgement on ACA at all, just suggested that we learn about its opposition and, as you rightly point out, the difficulty of passing such legislation that can last over time. I agree that "To no avail" could be read as "was worthless" to an adversarial reader, but trust me when I say it was meant as "which didn't save it from being opposed and stripped over time". As in "the studies and facts don't move the politics" It should be obvious the messaging is oppositional along party lines. Every chip away at ACA makes it a worse program, and is celebrated by half the electorate. This is a core problem with the legislation. A second iteration on top, or in place, would have to learn from this and work to make the program stickier.

slg 2mo ago

>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. The failures and politicization of the ACA have caused us to be a little too dismissive of its successes and popularity. Protections for pre-existing conditions and allowing children to stay on family plans until 26 in particular have made an incredible difference in a lot of people's lives and are wildly popular. So much so that it would be close to political suicide to try to remove them as evidence by Republicans controlling all three branches of government including both chambers of Congress and there is no serious talk of repealing them. There is belief among a lot of its supporters that universal healthcare would have a similar wave of support if enacted and that the opposition is mostly irrational political arguments rather than people's true feelings about an actual policy. This is why the "ACA" polls higher than "Obamacare" despite those being two terms for the same legislation.

pyronik19 2mo ago
ACA is horrible for the middle class. The only reason it retains any type of popularity is because the media refuses to associated ballooning cost to cost redistribution that it enables. Preexisting conditions? Middle class family picking that up. Subsidy? Middle class family picking that up.
- ComputerPerson 2mo ago
  This is unfair to the ACA and factually incorrect. ACA subsidies (median household size) [1] are designed to start above the 50th percentile (income) [2]. The details matter. If you're a single person living alone at an income of $70,000.00, you're below the median household income and "picking up" other people's subsidies, but that's not indicative of the country. [1] https://www.healthcare.gov/lower-costs/ https://www.healthcare.gov/lower-costs/ [2] https://www2.census.gov/programs-surveys/demo/tables/p60/286/tableA3.xlsx https://www2.census.gov/programs-surveys/demo/tables/p60/286...
- nradov 2mo ago
  In a wealthy and civilized society we have a moral obligation to care for all of our citizens. Some of them have pre-existing conditions and can't afford to pay market rates, so the middle class is going to have to subsidize them one way or another. Whether that subsidy comes in the form of higher insurance premiums or higher taxes hardly matters.

jtbayly 2mo ago

I lost my individual healthcare plan, and I couldn’t afford the new ones. Remember when they said you could keep your plan? Yeah, that’s the one I lost.

QuercusMax 2mo ago
There was never a guarantee that you were going to keep your plan anyway, was there? Insurance companies are changing plans from year to year.
- jtbayly 2mo ago
  The plan was cancelled because of ACA requirements. I had had it for several years prior. Yes, plans change, but this was different.
  - QuercusMax 2mo ago
    Which requirements made them cancel it? Was it a high deductible scam plan?
    - jtbayly 2mo ago
      It was a high deductible insurance plan, not a monthly subscription to all your healthcare needs. Why would you call that a “scam”? And for the record, it was not as high a deductible as most “silver” plans on the exchange currently.
      - bonsai_spool 2mo ago
        > It was a high deductible insurance plan Why do you believe that the ACA would have wanted such plans cancelled? There's a very straightforward public health reason that's reminiscent of why states require drivers to have car insurance. > And for the record, it was not as high a deductible as most “silver” plans on the exchange currently. The plan would have been in effective over 18 years ago. Does your internet plan look the same now as it did 18 years ago? Your cell phone plan?

th0raway 2mo ago

No system that saves money can pass in congress: that's the real problem that we cannot actually avoid. Forget pressure from large companies: So many of US costs come from very high salaries, and a lot of bureaucratic positions that don't exist elsewhere. Every dollar we pay goes to someone, and it's not just some random mogul here or there that will be OK anyway. Reform that really lowers prices means loss of jobs, which them will be blamed on the politicians who signed the bill into law.

sys32768 2mo ago

Pre-ACA, I could afford family insurance. My family premiums went up ~$500 a month post-ACA, while the coverage worsened. My afib ER trip three years ago cost me $7k out of pocket even though I left the hospital still in afib. Today in my 50s, my deductible is now $8,500. My partner doesn't have insurance because she's not poor enough or rich enough. We had an insurance rep come to my work last year who said after ACA they had some people whose premiums went up 900%. So yeah, ACA is better in your world, but not in mine.

unnamed76ri 2mo ago
Yep. We were promised it would save us money. Instead, healthcare care costs skyrocketed thanks to Obamacare.
elevation 2mo ago
Yeah, since the ACA my coverage has remained the same while my costs have risen 10x; I'm in my 30s and my medical insurance costs 3x what my mortgage costs, and I still have $$$$ sized bills after a round of strep throat. I would really like to just be able to get a true catastrophic policy which would cover unlikely risks such as cancer -- and then go on a cash basis for common meds and treatments. The ACA made this kind of insurance illegal, so my choice is to leave my family uninsured -- or let insurance soak up the money I might have saved for their college education.
nradov 2mo ago
Your blame is misplaced. Costs are increasing in spite of the ACA, not because of it. Pre-ACA your family insurance policy was likely worse in some key ways: it probably excluded coverage pre-existing conditions and had a lifetime maximum coverage limit.
- missedthecue 2mo ago
  But then the blame might be correctly placed? If he had no pre-existing conditions and was on a no-existing conditions plan, that plan might have saved him a lot of money. Imagine car insurance regulations changing in such a way to force underwriters to blanket-assume everyone has had a couple speeding tickets this year. I understand why we do it. We are ok with speeders paying more for insurance, and not ok with someone born with diabetes forced to pay more for health insurance. But it is the end result in any case.

yieldcrv 2mo ago

Republicans finalized things to address medical costs and chiseling at hospital billing - regulations promulgated during Democrat regimes - so I would say there is bipartisan consensus for the actual arguments, if people listened to the actual arguments instead of seeing a no-vote as an opposite nonsensical ideology. This has been one of the opposition points - don't just give a handout to insurance companies without addressing their billing practices The original ACA did not have consensus for some of the proposals to address the billing practices such as existing and new state healthcare programs having collective bargaining. And yeah I think the original ACA was unworkable, compromise is taught as a good thing to children in this country, but it just means "the wrong answer". The tweaks now, alongside the original democrat led ACA, alongside the parts that were stripped out I think could have better consensus does need a rebranding though. The only thing that will actually lower costs in our society is healthy people. And right now, everyone is unhealthy and not doing preventative measures due to expense.

cactacea 2mo ago

> These are life-changing possibilities, especially for entrepreneurs. I would quit my day job and completely focus on my side business if I didn't have to worry about healthcare.

etchalon 2mo ago
I was wondering one day why it seemed like so many YouTubers were Canadian. The "well of course" moment took me a day longer than it should have.
hombre_fatal 2mo ago
I also think about people stuck in bad relationships they'd otherwise leave.
toomuchtodo 2mo ago
Part of the reason why there is no effort to fix this, to keep you a slave to a job that provides healthcare. Imagine the reduction in labor supply and increase in labor costs if healthcare did not require employment. On can, in many cases (facts intensive), bail to a developed country with healthcare if you want to realize this dream earlier than whenever the US will achieve the outcome (and your life situation supports doing so). It could potentially takes years, if not longer (~5-10 years), for the US to fix healthcare as the situation continues to degrade for those who need affordable healthcare today. https://news.ycombinator.com/item?id=47161587 https://news.ycombinator.com/item?id=47161587 (expat resources for those potentially interested) https://relocateme.substack.com https://relocateme.substack.com (a product of andrewstetsenko here, no affiliation, I just like resources that can help humans achieve their success criteria) https://healthcareinfusion.org/ https://healthcareinfusion.org/ (for healthcare workers interested in Canada, likely does not apply to many here, but please share with others who might be seeking a path) (i see this problem as a vulnerability management and exposure exercise to attempt to solve for, ymmv, no affiliation with any resources recommended)
- tptacek 2mo ago
  That's not how this system came into being. It's a path-dependent quirk of the tax codes of the 1940s. We got into this predicament because of WW2-era wage controls (a dollar spent on health care by your employer was literally worth more than a dollar in wages). This is one major reason why most of the world's universal systems make private insurance work, and it doesn't blow up the way ours does. But I don't think employers are any happier about it than you are!

expedition32 2mo ago

The real problem with universal healthcare is that it immediately completely eradicates religious charity. Any single mom who works as a stripper can go see a doctor who doesn't have the slightest inclination to judge- you're just a number in a government database. Everyone's getting free shit no questions asked.

edoceo 2mo ago
Where is the problem here? Religious charity exists in places with universal healthcare.
Telemakhos 2mo ago
I don't know that "inclination to judge" is a necessary component of religious charity. Religious charities beyond healthcare give out a lot of "free shit no questions asked," and usually without any attempt at proselytization. Catholic hospitals are not known for turning down patients due to moral judgements. If there's a benefit to religious charity, it lies not in the "inclination to judge" but in maintaining a multiplicity of authorities. Combining everything under the government umbrella gives you a totalitarian society; a liberal democracy restrains the power of government while allowing for competing authorities in other spheres, like medicine, religion, academia, and the press. Giving the government the power to mandate or withhold medical treatment for political opponents (think Soviet "sluggish schizophrenia" as a diagnosis for removing dissidents from public life) seems more worrying than strippers getting free healthcare.

jandrewrogers 2mo ago

ACA also greatly increased costs. As an entrepreneur at the time, insurance premiums increased 25% overnight for the same plan. Many people had similar experiences. That the ACA forced a large number of people to pay a lot more for literally the same product is not a good outcome for those people. Too many people try to pretend this didn't happen.

tptacek 2mo ago
No it didn't. The ACA slowed cost growth, which was already skyrocketing by the time it passed.
- jandrewrogers 2mo ago
  The sharp discontinuity in insurance costs over a single year for many people when ACA went into effect isn't explained by your dismissal.
  - tptacek 2mo ago
    All the stories I've heard about that came from people with bad insurance (for instance: insurance programs that could rescind coverage if you were diagnosed with something serious, and that functioned mostly as billing processors for routine care, which is where ~none of the expense in the system is). The ACA did effectively regulate those plans out of existence, so if you had one, and relied on it, it raised your cost. But when we talk about the ACA's impact on cost, we're always talking in a macro sense. Every program has individual winners and losers.
  - cyberax 2mo ago
    Insurance prices _dropped_ in NY after the ACA was enacted. Not "slowed down the growth" but actually dropped in absolute numbers. That's because NY had enacted a coverage mandate even before the ACA, so insurance companies were forced to offer policies to everyone. This resulted in a runaway spiral where only sick people were getting insurance. The ACA forced all large employers to buy insurance, greatly increasing the risk pool.
- 2mo ago

tptacek 2mo ago

I agree with you about the ACA (as an opponent of single-payer). Prior to the ACA, members of my immediate family were uninsurable on the individual market --- not insurable at a higher rate, not insurable with exclusions, but literally uninsurable: their only options were employer-provided group coverage or state catastrophic safety net coverage programs. The twist: neither has any chronic health conditions. The underwriting refusals were based on symptoms reported in previous engagements with the health care system.

Pragmata 2mo ago

>ACA has saved tons of lives. The ACA has killed a whole lot more lives than it has saved by causing healthcare costs to spiral up. If you begin with something that is obviously incorrect and trivially debunkable, perhaps that's indication that you should review your priors.

jonhohle 2mo ago

Before I went indie, prior to ACA requirements I researched private insurance and found plans for around $3K. This year I’ll pay over $20K for a bronze plan for my family. 700% increase in less than a decade. Aetna left the marketplace input state and no pediatrician in a 10 mile radius takes the most cost effective ACA plan. The pediatricians we found are actually just GPs who have training in pediatric medicine, but we bring in the only minors they see. This is in a top-5 market based on population. All of the providers have consolidated. I don’t know if ACA affected that or not, but wait times for checkups went from later this afternoon to sometime 6 months from now. Part of my experience is going from corporate health insurance to marketplace, but in the past 5 years, ACA plans have consistently gotten worse and more expensive while service for those plans has gotten significantly worse in almost every way. Who is it better for?

lotsofpulp 2mo ago
ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. You are paying more because a lot more healthcare is being delivered, to people who never used to either due to exceeding maximum benefits (we have the opposite today with out of pocket maximum), or being denied for pre existing health conditions. So to answer: >Who is it better for? My 4 year old, who has received hundreds of thousands of dollars of cancer treatment, and will need a bunch more over the coming years.
- pyronik19 2mo ago
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- jonhohle 2mo ago
  > ACA premiums are literally taxes, the price you pay has nothing to do with your health risks. Then turn it into a tax and be done with it. I don't shop for my tax collector and I don't pay taxes to companies with the biggest buildings in the city. Companies that don't actually provide health care, but just collect their pound of flesh from patients and providers, driving up costs for everyone. I'm glad your child has received care. I'm very much behind the idea that pre-existing conditions should not preclude anything from receiving _care_. I'm completely opposed to mandating a private 3ᴿᴰ party be between me and my provider.