[frockington]

As much as dissapointment the Affordable Care Act was, at least someone tried something. If only we could learn from those mistakes and make incremental changes. Politicians are to obsessed with either tearing it all down or healthcare for all for "free", no middle ground

[stephengillie]

We have a single-payer system - Medicare. ACA is just a jobs program for the insurance industry, perpetuating 2 types of bullshit jobs: medical billing and medical underwriting.

[nradov]

Medical "insurance" companies actually don't do much underwriting any more. Most policies are self insured by large employers. The insurance company just manages the provider network and administers claims.

Even medical billing is gradually going away with the shift to value-based care and accountable care organizations (ACOs).

[Frondo]

Not free and no one's saying that. Free at point of service, like the NHS or the Canadian health care system, yes, but obviously everyone knows we'd pay for it with taxes.

We could just do it, cover everyone, for less than we're paying now, by rejiggering the system under a "medicare for all" banner. There aren't any other serious options on the table. (replace and repeal, or whatever, is not a serious option.)

[ssambros]

Medicare currently pays less than what it costs to provide for a lot of services. And providers are either declining medicare alltogether or recouping the missing funds from the other patients. Where would all those other patients come from if medicare will be "for all"?

[maxxxxx]

"Medicare currently pays less than what it costs to provide for a lot of services"

Is that even true? Personally I have my doubts.

[ssambros]

American Hospital Association: Underpayment by Medicare and Medicaid Fact Sheet, December 2017 Update [0]

FINDINGS

In the aggregate, both Medicare and Medicaid payments fell below costs in 2016:

- Combined underpayments were $68.8 billion in 2016. This includes a shortfall of $48.8 billion for Medicare and $20.0 billion for Medicaid.

-For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2016.

- For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016.

- In 2016, 66 percent of hospitals received Medicare payments less than cost, while 61 percent of hospitals received Medicaid payments less than cost.

[0] https://www.aha.org/data-insights/2018-01-03-underpayment-me...

[maxxxxx]

After having dealt with billing from hospitals for services they never delivered or obscenely overpriced I am inclined not to trust them on statements about their actual cost. In my view the billing practices of most hospitals are very dishonest and intentionally confusing and opaque.

[ssambros]

"billing practices of most hospitals are very dishonest and intentionally confusing and opaque."

Is that even true? Personally I have my doubts.

[SketchySeaBeast]

> For Medicaid, hospitals received payment of only 88 cents for every dollar spent by hospitals caring for Medicaid patients in 2016.

Is that the actual cost of the item or the obscene markup? Is medicare only paying $2.20 for the $2.50 saline bag, or are they only paying $176 of the $200 charge?

[frockington]

As a taxpayer I would be in favor of a more equitable system where everyone has a line item brought to their attention. There may be a use case for UBI here, everyone gets a stipend or a tax cut that they can use to either get healthcare or not. I'm getting tired of all of the taxes and how easy it is to paint tax payers as evil rich people who need to give more with their hard earned money

[cmurf]

PPACA is the incremental change. There wasn't the political capital to effectively destroy the health insurance industry by leaving only VIP insurance (really it's not insurance, it's a "pay extra to cut in front of the line" product).

Democrats apparently didn't have the votes to even make Medicare or Medicaid an optional buy-in, to compete with marketplace insurance. This in particular is necessary in a huge land area of the U.S. where there's only one or two insurance providers.

[masonic]

  Democrats apparently didn't have the votes

Democrats had the only votes and the only say in every element of "Obamacare". Republicans were not even allowed to see the bill before the vote was taken, hence zero Republicans voting for it.

[dragonwriter]

> Democrats had the only votes and the only say in every element of "Obamacare".

That's not actually true (Republicans had a significant say, even though thet universally ended up voting no), but even if it was the public option had long been controversial among Democratic politicians despite it (and even moreso simple single payer, which had a majority support ) long being overwhelmingly popular among Democrstic voters and having stronger support nationally than the purchase mandate w/o public option approach.

> Republicans were not even allowed to see the bill before the vote was taken,

Yeah, they were, they were also involved in the Committee process in the Senate in which it was drafted. They also filibustered it for quite a while, which gave them even more time in which to read it.

And of course Republicans in the House had still more time to read it, since it was voted on in the House after the vote in the Senate.

There are lots of reasons you can argue might have been behind Republicans voting against, not being allowed to read it is not one of them.

[ahoy]

The ACA was the middle ground and it's still bad.

[frockington]

I agree with you, I'm saying we should learn from the mistakes and iterate on the current instead of fighting for extremes that will never work or be passed

[maxxxxx]

One thing the Republicans could have done was to iterate on Obamacare instead of trying to repeal it for 8 years and now that they are in power they show that they have no ideas and no interest in improving anything.

[rectang]

While I think there's something to your point here, I wish for the sake of avoiding flamewars per the HN guidelines you could put it in less partisan terms. (For example by avoiding naming specific political parties.)

I would have liked to see more experimentation on price transparency.

[maxxxxx]

Totally agree about price transparency. Everybody but the people in the medical system who benefit from opaque pricing should be able to agree with this.

I don't think my comment was partisan but it was a description of the last 10 years. Republicans voted to repeal Obamacare several times a year but never introduced anything for improving it. And now that they are in power they seem have no idea how to proceed.

I am not saying that Obamacare was a good law. Actually it was pretty half assed but it could probably be made to work with some changes. I would have loved it opponents of it would have introduced steps for improvement but they never did.

[rectang]

If we avoid finger-pointing it is easier to find common ground.

I like the concept of the ACA as integrating markets and competition, as opposed to price fixing. Healthcare is a terrible example of market failure which requires some amount of regulation -- I wish we could iterate on which regulations were worthwhile. Instead we have this all-or-none regulation-vs-no-regulation. :(

[cmurf]

How are facts partisan? It's been the stated party platform from the moment it became law.