[hardcandy]

I've been self-employed for about a decade. Prior to ACA I had catastrophic insurance with IIRC about a $10k deductible for 25% of the ACA cost. But I was a healthy, non smoking male in my mid 20s (back then) with no pre-existing conditions. If you had pre-existing conditions then it doesn't surprise me that your ACA rates were the same or lower, which illustrates what ACA really is: a subsidy (tax) helping out the (mostly) old and (mostly) chronically ill paid for by the (mostly) young and (mostly) healthy. I prefer not to think of it as red-versus-blue partisanship and instead in objective economic terms. Personally I have no problem subsidizing people who are born with chronic illnesses, or fall on hard times; I have a few cancer survivors in my immediate family and I've seen the impact it can have. But I don't think that we should be subsidizing people who have diseases borne of negligence (adult onset diabetes and other obesity related diseases) who refuse to do anything to help themselves and as a result consume extreme amounts of health care resources. It's becoming clear that for the time being at least demand far exceeds supply in the health care services market, and that means having to decide how and when to ration care. I can afford to pay inflated ACA rates and I can afford to pay for private concierge-style care in the face of a supply-demand imbalance in the market. But what about the middle class family making $50k/year who is now spending 20% of their net take home income on health care? Unfortunately there aren't many easy answers in this debate and it's especially difficult to even start the discussion given how polarized it has become.

[rogerbinns]

Why should people who live further north have to subsidise those in more southern sunnier climate and are more likely to get skin cancer? Why should I as a non-rock climber subsidise those that do? Why should those without children subsidise those who do? Why should those in walkable cities subsidise those who drive more in less walkable ones? Why should those who have taken a vow of abstinence subsidise those who haven't? For virtually everyone there are always some discretionary choices they make that increase their health risks.

There is a fix, but it involves government taking a big picture view. Stop subsidising bad food, and ensure people have as good access to "good" food as they do to bad. Provide youth centres and similar community access to places where people can get into the habit of exercise. Examine transit and see how to get people to spend less time sitting in cars. See what can be done about improving the quality and happiness of all citizen's lives. All of this isn't instant or a magic wand, but is something that can collectively help a lot over time.