[lmm]

> The last time democrats controlled presidency and both houses was during Obama's first term and they passed the most historic overhaul of healthcare in this country, which was a huge win for women's healthcare.

Was it? From a foreign perspective it doesn't seem to have changed the conversation around US healthcare at all.

[Brybry]

Before ACA you could be denied health insurance or coverage due to pre-existing conditions (or they could charge you so much that it was infeasible to get insurance).

This was huge because if you ever lost insurance and got new insurance (switched jobs) then you were often screwed.

ACA defined essential benefits. Before ACA insurance usually didn't cover things mental healthcare. Required coverage of preventative care/screenings/reproductive care for women.

Annual and lifetime coverage limits were banned. Your health insurance could no longer drop you because you got an expensive to treat cancer.

The amount of desperately needed consumer protections ACA added were immense.

Sure there are problems with ACA, especially the marketplace part of it, but overall it was a big change to healthcare in the US.

[amluto]

> Sure there are problems with ACA

That’s putting it mildly. Sure, the ACA was, in many respects, a big improvement over what came before it. But it’s still outrageously broken. Let’s consider the perspective of a person who wants health insurance:

1. You mostly want to be insured via your employer, and you mostly get screwed if you leave your job. The financial disincentives to insuring yourself are huge unless you qualify for the subsidies.

2. For some bizarre reason, you can use only buy insurance at some times of the year.

3. You more or less have to buy insurance through a website that is massively and incomprehensibly bad. Want to figure out what that insurance covers? It’s sort of doable, but it sure isn’t easy.

4. Whether or not you will get to fill a given prescription still seems arbitrary and vaguely malicious.

5. The whole system rubs the insane list prices of healthcare in your face, almost continuously. For drugs, even small amounts of Internet searching points out how much cheaper they are basically anywhere else.

It’s really hard to be excited about the ACA.

(For added fun, and this isn’t really the ACA’s fault but it sure is a failure of affordability and sure seems like a massive failure of government: check out hims.com. Pulling a random example, “generic for Cialis” is at least 3x the price on hims.com as it is via GoodRx.)

[prewett]

And if you are relatively healthy and able to pay your regular doctor bills out of pocket, ACA made catastrophic insurance illegal (because of the minimum requirements). It's sort of like making car insurance require $50 copays to the mechanic. Sure, it's nice if you need an engine rebuild, but paying for all that makes the insurance a lot more expensive if you have a reliable car. There's no need for me to pay the doctor's bill and the insurance company's profit+overhead, I'd like to have the option to pay normal stuff myself and only insure something too large for me to pay.

[jampekka]

If healthy people could opt out of insurance, it would get really expensive for the not-so-healthy. That's why mandatory insurances are quite common.

Wheter it's a good idea to do this via private for-profit insurance and healthcare is another question. I prefer to just pay it via taxes.

[nradov]

This might not be quite what you want, but the ACA does allow for High Deductible Health Plans (HDHP). Those have consumers paying out of pocket for normal stuff, using a Health Savings Account (HSA).

https://www.healthcare.gov/glossary/high-deductible-health-p...

[amluto]

Which are, nonetheless, rather impressively worse in basically all respects than the old medically underwritten individual plans. Other than the fact that anyone can get them, of course.

I’m not saying that the ACA was a bad law. I’m saying that a not-so-nerdy voter contemplating whether ACA is a great achievement of the Democratic Party is likely to be unimpressed.

[nradov]

Worse in some ways, better in others. The old individual plans usually had serious limits on coverage of pre-existing conditions. And they had lifetime coverage limits which could be exhausted by a single serious illness or injury.

[jjav]

> It’s really hard to be excited about the ACA.

While your complains are all true and the ACA is a mess compared to any developed country, it is still very exciting to have the ACA. For anyone who was barred from getting insurance before, it is the lifesaver, literally.

Compared to other countries, ACA isn't very good (to put it mildly) but compared to how the US was before it, it is the most wonderful improvement ever.

[lokar]

Re: 2

You can use a broker (free to you) and get the same (regulated) plans. If your situation is at all complicated you should definitely use one. Probably even for “simple “ cases.

[t-3]

It was a great thing for the people who most needed healthcare, but it priced me (young at the time and healthy) out of the market. I went from having cheap employer-sponsored healthcare to not being able to afford it (literally from less than 10% to ~50% of my paycheck).

[pmontra]

I'm from the other side of the Atlantic. Do you mind explaining how that happened?

To give you some context: every country is different here but usually we have an almost free healthcare system covering everything for everybody (but sometimes you have to wait for a long time) and private healthcare that is more expensive, usually faster but not necessarily better.

[arethuza]

"usually faster but not necessarily better"

Here in the UK my wife and I have between us spent a fair bit on private medical care over the last year - in the case of my wife for cataract operation on both eyes and in my case dental implants and related procedures.

What I find amusing about private health care in the UK is that in each case I have ever used it they make it clear that if something goes seriously wrong they will take you to an NHS hospital.

[FirmwareBurner]

>What I find amusing about private health care in the UK is that in each case I have ever used it they make it clear that if something goes seriously wrong they will take you to an NHS hospital.

Privatize the winnings, socialize the losses, the "free market" working as intended.

[t-3]

Most of the prices going up for young and healthy people is just the math insurance companies have to do when they can't deny people and have to provide more coverage.

The part where we don't have the free healthcare system is mostly due to politicians being afraid of socialism or being afraid of raising taxes or both and a very strong medical lobby that doesn't want the salaries of doctors (very high over here) to drop.

[greentxt]

Imagine if you could buy car insurance after you crash your car.

[FireBeyond]

Huh? The "car crash" in this analogy is "losing your job", which has nothing to do with your health profile.

[heylook]

And in that circumstance you are allowed to maintain your health insurance (COBRA) or buy a new plan ("qualifying life events," which also includes things like marriage and moving).

The comment you're responding to was alluding to if people could choose to not pay for health insurance until after they got injured or sick and then needed the benefits.

[throwaway2037]

Can you explain this more to me? What does it mean to be unable to afford healthcare? As I understand, it is a law that you must have it, or you pay a fine to the IRS by your tax return. Do you really have no healthcare now?

[t-3]

Unable to afford healthcare is pretty straightforward, I think. My plan went from being a relatively small amount I would pay for peace of mind, to being a giant expense that would leave me destitute. As far as the fine, if it hadn't been revoked it would just come out of my tax return, so "paying" would have been no big deal. Yeah, still don't have healthcare. I realized I don't need it much and became more fatalistic after living without it.

[throwaway2037]

That is an unbelievable story. Thank you to share. Stories like this keep me coming back to HN. It is crazy to think that you are gainfully employed, but cannot afford healthcare. I wish you good health!

[jmpetroske]

There are no longer fines in your taxes for not having insurance. That law was revoked

[vcxy]

Yeah, it was a pretty big change actually. You're right though, the conversation didn't change much even as access to healthcare did change.

[weard_beard]

Yeah, access. That’s what we were all freaking out about. Lack of access. That’s what makes our system different from the rest of the western world. Access. Glad we’re drowning in access.