[toomuchtodo]

Hey there! Long term Obama supporter (no longer) and healthcare consumer in the US. I agree with you mostly.

Monthly premiums for my wife and I are ~$700/month (both healthy, early 30s, Blue Cross Blue Shield). When our daughter arrives shortly, that will increase to $1000/month. That's a high deductible plan where we're out of pocket for everything for the first $6000/year.

I work remotely, so we're looking at moving to Central America (Panama or Belize, wherever its cheaper to dock a 40' catamaran); if you live outside the US more than 330 days/year, you're not obligated to carry insurance. I can obtain expat insurance, that covers my entire family in every country in the world except the US, for $3000/year. $9000/year after-tax savings is nothing to sneeze at.

The ACA was a sham; it measures the insured rate, not the ability of citizens to receive the care they need. On that metric, its failing terribly. But health insurance companies are doing well at least.

EDIT: I have no problem with universal healthcare. I believe greatly in it. I despise that the federal government didn't eliminate health insurance companies entirely and move to single payer through Medicare.

[davidw]

I'm pretty happy to have moved back to the US from Italy for a number of reasons, but the health care system isn't one of them. It's way, way too expensive for what it delivers: just look at costs as a percentage of GDP. It was pretty bad before, and hasn't improved a lot with this reform.

[toomuchtodo]

Indeed. The US has the highest cost of healthcare as a percentage of GDP, with worse outcomes compared to most other first world countries.

http://www.commonwealthfund.org/publications/issue-briefs/20...

[dragonwriter]

> I despise that the federal government didn't eliminate health insurance companies entirely and move to single payer through Medicare.

Medicare isn't single payer. Its actually very similar to the ACA exchange system, only with a public option alongside private options (all of which must offer at least as much coverage as the public option, and which are partially publicly subsidized for people choosing them instead of the public option.)

(And, in the case of prescription drugs, with a big hole in the public option, for which, if you want coverage, you either have to reject the public option or purchase a publicly-subsized private plan to cover that hole on top of the public plan.)

Medicare was a single payer system, back before most of the people posting on HN were alive.

[maxerickson]

Several large insurers are planning to withdraw from the marketplaces because they are losing money on the plans they offer there.

[toomuchtodo]

You're correct. They are losing money, and they are withdrawing from those markets in question.

Its important to note that the backstop payments those insurers were to receive from the federal government are being tied up by Congress, to stick a wrench in the ACA.

http://www.thefiscaltimes.com/2015/12/17/Congress-Weakens-Ob...

The elephant in the room is: How do we spend less on healthcare for everyone when so many people have vested interests in the status quo? Change must come from the outside, and must be applied with force.

[maxerickson]

I guess. Congress preventing Fed Gov from reimbursing insurance companies for their huge losses isn't really evidence that those companies are doing well though.

[mrfusion]

Why are we going to end up with single payer? I didn't follow that part of your argument.

[toomuchtodo]

I removed that part of my comment, as I thought it was not relevant to the specific point.

As the US population ages, more and more people will be on Medicare [1]. This increases its power, and removes almost entirely the likelihood it would be scaled back.

We will eventually have no choice but to move to single payer, as the cracks in the current model (dictated by the ACA) are already forming.

[1] https://www.census.gov/prod/2014pubs/p25-1140.pdf (warning: pdf)

[alexose]

> The ACA was a sham; it measures the insured rate, not the ability of citizens to receive the care they need. On that metric, its failing terribly.

Can you elaborate on this? Not because I think you're wrong, but because I haven't been able to find any data one way or the other about health outcomes and the ACA.

[toomuchtodo]

It simply mandates everyone buys insurance. It does not mandate affordable care. Does it matter if you buy insurance if your deductible is $6000 and you never seek medical help until its too late (because you can't afford the copay(s))?

[dragonwriter]

> It simply mandates everyone buys insurance.

It mandates everyone buys insurance meeting minimum standards.

> Does it matter if you buy insurance if your deductible is $6000 and you never seek medical help until its too late (because you can't afford the copay(s))?

By definition, with "too late" as part of the premise, no; but more meaningfully, it definitely makes a difference if you buy a high-deductible plan and only use it to cover catastrophic costs.

(Of course, to meet the minimum standards under the ACA, plans must cover certain, mostly preventive, services at no cost to the covered individual, regardless of what co-pay and/or deductible they have for other services, so that also makes a difference.)

[burkaman]

Right, but are there any studies or statistics on how the ACA has affected actual care provided, or hospital visitation rates, or something? What makes you say the ACA is failing terribly on this metric?