[opportune]

This is it. Both parties have failed with healthcare - Republicans through complete inaction, and Democrats through pushing through legislation that simply expanded insurance coverage. While I think the ACA made things better than before (it got a lot more people insured and thus no longer easily susceptible to medical bankruptcy), it was a very imperfect and inefficient solution.

Because of the donors to each side - small government boosters like the Koch’s for the Republicans, insurance and pharmaceutical companies to the Democrats - it’s going to be very hard to move to a single payer solution. Even if you don’t think that’s the right way to handle it, you must admit that there is not much money behind it

[tzs]

> While I think the ACA made things better than before (it got a lot more people insured and thus no longer easily susceptible to medical bankruptcy), it was a very imperfect and inefficient solution

Could they have done better?

Normally a big bill like this would pass the House. Then the Senate would make several changes in order to get enough votes to pass there. Then it would go back to the House, where the House would make another round of changes...then back to the Senate, and so on.

But in this case, that stopped early. It came from the House. Changes were made in the Senate that were able to get it through, 60-39 (60 were needed because Republicans were filibustering). One of those 60 was from the person temporarily filling the seat of the recently deceased Senator Kennedy.

It went back to the House, and while it was there the special election to fill Kennedy's seat was held, and a Republican won, and the Democrats lost the ability to break a filibuster.

So the Democrats in the House went with the bill as it came from the Senate, because that was the only thing they could pass that would not have to get past a Senate filibuster. (They were able to make some changes separately, because some of the changes they wanted, such as some relating to subsidies, because those counted as budgetary changes, and there is a separate procedure for reconciling budget changes between the House and Senate that is not subject to filibuster).

Wikipedia has a good, detailed, account: https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...

[davidw]

Why bother with pesky facts when there's astute sounding 'both sidesism'.

[nkw]

I'm actually surprised there has not been more pressure by the business community to decouple health care/health insurance from employment. Health insurance costs, and the administrative effort to provide it, are an enormous burden on businesses/employers. From small business to giant corporations, it is an extraordinary burden that is only going to increase and at some point is going to start seriously impacting the competitiveness of US business. It should be an issue the Republicans have front and center.

[gremlinsinc]

Actually, businesses love healthcare coverage. The most costly thing in a business (esp. tech) is recruitment. If you give awesome benefits, a lot of people might decide it's 'safer' to stick with your company even though they're burned out and would rather work for an exciting startup, or something.

Benefits are a tool to turn workers into slaves, and stop job mobility. Sure there are other benefits, but healthcare is the biggest and most costly. The better health a company gives the more likely employees are to stick with it.

[davidw]

Yep, don't forget that market friendly and business friendly (and especially big business) are two different things.

https://promarket.org/donald-trumps-economic-policy-pro-busi...