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> Why should society pay for these choices?

Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to pay the resulting bill (maybe declaring bankrupcy), and someone then has to eat/cover the cost. Often by hiking prices for those that do have coverage.

Do a search for "ACA three legged stool":

> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.

> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.

* https://archive.is/https://www.nytimes.com/2017/07/10/opinio...

This 'architecture' was developed by Jonathan Gruber:

* https://cdn.americanprogress.org/wp-content/uploads/issues/2...

* https://en.wikipedia.org/wiki/Jonathan_Gruber_(economist)

It is a form of social safety net.

▲ mgh95 a day ago | parent [-]

> Because it's the only way to get universal coverage, which if you don't have, means a portion of the population gets really sick, jams the ER, can't afford to pay the resulting bill (maybe declaring bankrupcy), and someone then has to eat/cover the cost. Often by hiking prices for those that do have coverage.

The alternative that is always there is to repeal EMTALA.

This misses the problem: [the ACA causes a moral hazard for lower classes likely to use it.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8567089/)

The issue is a policy designed for a highly uniform, high social class, high status state (Massachusetts) was applied to the USA as a whole.

▲ PaulDavisThe1st a day ago | parent [-]

> The alternative that is always there is to repeal EMTALA.

I suspect you think it's not great having homeless people on the street.

Wait till you see what it looks like when they actually start dying in the street because emergency health care is no longer available to them, nor to many of their housed neighbors, family and friends.

▲ mgh95 a day ago | parent [-]

I don't see what EMTALA has to deal with homelessness in this context. It largely comes down to uninsured, even post-ACA. If we can't afford the current system, it's not a matter of if, but when, either hospitals or providers leave medicare. To put it in perspective, the AMA reports (https://www.ama-assn.org/practice-management/medicare-medica...) that physician medicare compensation has declined 29% since 2001. At a certain point, it will simply be financially unsustainable. Whataboutism to distract from the fact that medicare alone is 3.7% of gdp and is forecast to grow to 5.1% by 2033 (https://www.cato.org/blog/fast-facts-about-medicare-social-s...) doesn't fix anything.

And FWIW, US Medicare spending alone is shaping up to grow to almost as much as some EU nations on a % of GDP basis (https://ec.europa.eu/eurostat/statistics-explained/index.php...).). Medicare isn't the solution. It's the problem.

▲ PaulDavisThe1st 14 hours ago | parent | next [-]

> If we can't afford the current system,

What we can and cannot afford is a choice, not some immutable fact of nature.

A cynical, if realist, version of this would be: if we choose to not spend any more ...

But that's still better since it acknowledges that we, as a nation, have agency in this.

▲ inferiorhuman 21 hours ago | parent | prev [-]

  And FWIW, US Medicare spending alone is shaping up to grow to almost
  as much as some EU nations on a % of GDP basis

Your source puts Austria, France, and Germany at the top, or roughly 11–13% of GDP.

https://www.bea.gov/news/2023/gross-domestic-product-fourth-...

https://crsreports.congress.gov/product/pdf/IF/IF10830

The U.S. Bureau of Economic Analysis puts the 2022 GDP at $25.46 trillion ($25,460 billion). Congress puts 2022 spending on private health insurance at $1,290 billion (5%) and Medicare at $944 billion (3.7% of GDP).

▲

mgh95 21 hours ago | parent [-]

Yes, we are tracking to grow to as much as some not all or most. Emphasis on tracking to grow which you should see the source for 2033 forecast.

The fact that one program (Medicare) is growing to be as large as the NHE should be cause for pause.

▲

inferiorhuman 18 hours ago | parent [-]

So your argument is that Medicare spending might potentially approach the same proportion of the GDP as a European country that doesn't spend a lot on its healthcare?

	▲	mgh95 10 hours ago \| parent [-]
		Pretty much. And that's just one program that services a small portion of the population. The issue is we can't make this level of spending work, why should we believe spending more money will be successful?