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by Chathamization 3216 days ago
> The ACA ("Obamacare") did a lot to make the US system look more like Germany and Switzerland.

In Germany you're automatically enrolled in public insurance unless you opt out and choose private insurance, no? That's completely different from the ACA, which has no automatic enrollments (if you're application gets stuck at the exchanges, good luck), no option to keep public insurance (if you're on Medicaid and you're income rises, you might have a month long gap between being kicked off Medicaid and getting a new health plan), pushes people into employer provided plans, and generally has a host of problems and complications that lead to 10.9% of Americans still be uninsured (and those who are insured still facing massive problems with healthcare costs).
1 comments
maxerickson 3216 days ago
I said "look more like". I even listed the things I thought were similar.

Automatic enrollment is rather obviously going to be more effective than a tax penalty, but the tax penalty is at least a mechanism designed to increase subscription.

There are a bunch of bad compromises in the ACA, but the comment I replied to was mystified that the US apparently isn't even trying things that have worked elsewhere, which is just wrong.

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Chathamization 3216 days ago
> There are a bunch of bad compromises in the ACA, but the comment I replied to was mystified that the US apparently isn't even trying things that have worked elsewhere, which is just wrong.

I'd say that they are right. The ACA is completely different from the German system. I mean, I could argue that the Republican healthcare plan is similar to the German healthcare system since it would have a public Government run system (Medicare and Medicaid) and subsidized private insurance (vouchers), but that's not a particularly compelling argument. When two systems are completely different, talking about a couple of ways they're slightly similar if you squint and don't look at the details doesn't seem particularly useful.

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maxerickson 3216 days ago
I guess I think that guaranteed issue of a plan with minimum standard coverage is a lot more important than the details of how payments flow through a system.

I'm certainly more concerned about the possible repeal of the federal insurance standards, the "essential health benefits" than I am eager for a public option to start competing with insurers (which I don't think insurers are doing a whole lot to either control or drive medical costs). I wouldn't mind a public option, I just don't expect it to matter much.

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