[b1daly]

You seem to be making an argument based on “semantics” here?

The idea of extending an insurance program into a mechanism for subsidizing those who can’t pay the premium does not mean it magically transforms the program into a totally different thing.

In the limited definition, it is still the case that the healthy pay the cost of sick.

The extension of the concept of insurance fits semantically, because it is based on the idea that there is an element of chance inherent in who gets sick; getting sick includes many factors that are outside the source of an individual’s contol (as well as factors that are within an individual’s control).

The ACA included a “tax,” among other methods to socialize the cost of covering the “premiums” for those that couldn’t cover them on their own.

The whole system relied on the same actuarial principles as the previous system to smooth out variance in costs to individuals.

Paul Ryan sounds like an idiot here, because he is a mealy mouthed politician, who doesn’t have the courage of his convictions.

Ryan is libertarian minded tool, whose real opposition to the ACA is not that the healthy pay for the costs of the sick. His opposition is to the elements of the program that force wealthier members of society to cover the medical costs of the poorer members.

[curun1r]

Yes, it's semantics...no quotes needed, that's what it is. But it's also people trying to make other people look stupid by being wrong, and they deserve to be called out for their improper semantics.

It's not "just insurance." That's not "what insurance is." We're talking about a form of socialized medicine, not insurance. That's the correct terminology. Anyone arguing for anything between Obamacare and Medicare For All (which includes me, BTW) needs to own up to that terminology or something to that effect and stop selling the notion that what they're arguing for is just insurance.

Insurance, as a concept, doesn't shift the burden for risk from people who can't afford to pay to people who can. It's something different and you don't get to alter definition of insurance just because the correct terminology has a stigma. So when the comment I replied to says,

> This is the whole point of health insurance!

No, it's not. That's the whole point of socialized medicine. Words have meaning and we should be using the correct ones.

[b1daly]

It’s true “Obamacare” is a form of socialized health care. But the bottom line is that it chose to implement the subsidization of poor peoples’ health care through the mechanism of health insurance. It’s simply not the case that poor people included into the plans are having their care covered through the mechanism of increasing the premiums of the healthy, which is what Paul Ryan is implying.

Poorer members of the insurance pool have their premiums subsidized. From the insurance companies point of view, they are (theoretically) managing the pool and premiums using the same actuarial tools they used previously.

The rules about not being able to reject people for pre-existing conditions force them to broaden the set of (heterogeneous) members included.

The plans are provided by “health insurance companies.” The product you buy from them is called “health insurance.” The imaginary, purist notion of what you are declaring to be “insurance” is like a simplified model of economic theory you might find in a textbook. It’s used to gain insight about how an insurance product works. There are no real world example of “health insurance” that conform to your simplified definition.

Health insurance in the US has long included coverage for routine care, which already falls outside of your model.

I’m of the theory that the meaning of words is defined by how they are used in everyday language, not how I think they should be defined.

[bzbarsky]

> because it is based on the idea that there is an element of chance inherent in who gets sick

That statement is true, but health "insurance" covers lots of non-chance things, because it covers lots of things that are not a result of "getting sick". Some examples:

* Birth control.

* Basic childhood vaccination.

* Well-child checkups.

* Annual health checkups for adults.

* Basic screening tests for adults (mammograms, colon cancer screens, that sort of thing).

All these things should be provided, imo; insurance is the wrong vehicle for providing them. Politically, I _think_ (hope?) there would be a lot more support for "provide all children with basic health checkups" than there is for the ACA. Of course there would be less support for the "birth control" item, which is why people like to bundle these all together, and with things like emergency medicine and end-of-life medicine. Which are _also_ quite different in terms of their risk profiles, tradeoffs, and elements of chance.

It also covers some things that in an ideal world would not be chance but are in practie (e.g. routine births with no complications; they are more chance than they should be because as a society we suck at birth control, on both the organizational and personal level).

I really wish we separated our "health care" a bit more along some of these axes, because I suspect that the "right" answer is to have single-payer for some aspects of it, an insurance scheme (private or public or both) for other aspects, and "you're on your own" for still others, with expensive and invasive end-of-life interventions heading this last list.