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0 pointsdmix9y ago0 comments

> then pointing to its collapse as if it was always fundamentally flawed

On the inverse, I see many people on the left pointing to the number of people who have signed up as the primary indication of it's success as well. Which contains it's own notes of ignorance.

Was the government not handing out fines to people who didn't sign-up? So they were basically forcing people onto the program? How could the numbers of sign-ups be meaningful then?

Also, I couldn't imagine going without health care. You have to take what you can get otherwise the risks are significant. So considering it's an essential service, saying "look at the number of people using it" as an success indicator is like saying "plenty of people are calling the firemen, clearly they are doing a good job".

There is a serious human cost here when people have their health plans doubling in cost... while the rest of the world has worked out far more functional systems. So those cost calculations should be relative to this high level reality, not some internal benchmarks between stages of mediocrity.

It seems by not deciding to be free market nor socialized that the US is getting the worst of both worlds. It's easy to blame the republicans for this but the half baked socialized system that the democrats put forward was hardly a good solution.

> Far too few people realize that much of the ACA plans' cost increases is due to Congress reneging on a government promise

Have you considered that maybe the entire Democrat plan of getting to a socialized system via cuts and slivers in one direction, knowing full well that cuts and slivers will be done in the other direction is a terrible idea?

Stop pretending that private companies can function efficiently in an ever more legislated environment, as if only more thousand page bills get passed that it will finally start working well... history has continued to indicate otherwise. Either a) embrace markets or b) go hard on selling the public on the idea of single payer public insurance.

(I should note I'm in favour of public health insurance after living with it in Canada, despite typically being in favour of markets elsewhere)

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agar9y ago· 3 in thread

Please don't assume my comment implies unvarnished support for the ACA. Except for the somewhat cynical last line, I tried to keep it fairly factual.

If you do want my personal opinion, I'll give it here:

1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power.

2. From a free market standpoint, the current model of tying healthcare coverage to your employer hurts both employers and employees. As an employer, why am I responsible for paying this "benefit"? If too many of my employees get horribly ill, my premiums go up to the point that I can't provide a competitive benefit; my costs increase, my employees' contribution increases, and my ability to recruit talent suffers. As an employee, why must I forego an entrepreneurial opportunity because I can no longer afford healthcare for my children without an employer footing the majority of the bill?

3. From an efficiency standpoint, the current model wastes tremendous medical resources (bureaucracy, physician time, lack of cost transparency, treatment limits, etc.). I have friends in the medical industry (doctors, executives, med tech providers), all of whom dream of a single-payer system.

4. From a constitutional standpoint, I believe healthcare falls under "promote the general welfare" and "secure the blessings of liberty to ourselves and our posterity." A national, taxpayer-funded health program is no different than any number of other government-funded programs that free us to maximize our potential as citizens. And yes, we pay taxes to fund those services whether we use them or not.

So yes, I'm a believer in a single-payer model. Yes, I believe the ACA is essentially a handout to insurance companies. And yes, I was very disappointed when Obama took single payer "off the table."

However, I also think it's better than pre-ACA, despite its flaws. And at this point, it's certainly better than the chaos that will arise from simply abandoning it. Understanding its compromises, I can't really envision a "replacement ACA" that will pass a Republican congress that can be better.

If Congress delivers a better ACA, I'll happily embrace it. Heck, I'd even give credit to the Republicans if they just tweaked the ACA, renamed it "Winningest Solid Gold Trumpcare" and fully backed the result to make it successful. But I see no positive outcome if they go down the "repeal and delay" path.

occamrazor9y ago

In all fairness, Switzerland and the Netherlands have privatised medical insurance with universal coverage and the people are generally satisfied. Other countries, e.g. France and Germany, have mixed systems which also work well.

The flaws of ACA are not inherent to a privatised system, they are the result of this specific implementation.

twoodfin9y ago

1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power.

Like the U.S. military has maximum negotiating power with its contractors? I mean, who else is going to pay for the F-35?

Monopsonies aren't inherently more efficient than monopolies.

agar9y ago

Nor are they inherently less efficient.

Do you truly feel military procurement is equivalent to healthcare delivery?

Have you ever sold products to the US government?

Do you believe the primary financial gains would come from negotiating power? (Hint, the list I provided is in order of impact.)

Are you familiar with the impact Medicare Part D had on prescription drug prices? (Spoiler alert: it "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients" [1].)

Do you believe the decisions behind funding defense are in any way influenced by non-economic factors? (Hint: defense budgets increase even when the military itself requests lower funding. Does government healthcare funding follow the same pattern? Why not?)

Are you familiar with the many estimates of the cost of a single payer program in the US? [2]

I could go on, but won't. This is not Reddit. Sound-bite caliber anecdotal arguments are a problem, not a solution.

[1] http://faculty.som.yale.edu/FionaScottMorton/documents/TheEf...

[2] http://www.pnhp.org/facts/single-payer-system-cost

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