High deductible plans are the norm because HSAs are basically free money. Maybe Obamacare really is to blame for shittier health insurance, but it's also possible that IBM is just paying relatively less than it used to. Employers can deposit into your HSA, which effectively lowers your deductible below the minimum required to qualify as a high deductible plan.

> ObamaCare made things much better for those who could not get healthcare.

For some people who could not get healthcare. I haven't had usable health insurance since before the AMA because it can exceed my total earnings.

> For most, High Deductible plans becoming the norm left people in much worse state

Which tees up my larger point (thank you).

For years 3 thru 10+ of the ACA:

    News orgs (eg KaiserHN): 'Insured are everywhere now thanks to ACA'.
        (As far as a policy was unusable, lumping those policy holders
        into the insured group - this was more a lie than not.)

    What I actually saw: Unusable policies due to copays.
        Policy quotes that approached or exceeded total earnings ($12k/yr)
        Policy quotes that went down as income went up.
             (quote for $22k/yr earner cost 50% more than quote for $32k/yr)

Mostly we didn't exist. Sometimes we did for 5 seconds if it was an opportunity to bash a politician we never voted for.

The problem with disregarding people in a destitute state is they mostly stay destitute. When the more fortunate cease being so, the people they couldn't care about are in no position to help - or even care.

[dead]

Same here, but without a known pre-existing condition. Before Obamacare, health insurance companies would not even write me a policy, and they would not tell me why. Just "nope, go away". So every day, I was rolling the dice, hoping to not get seriously injured or sick. The problem with Obamacare is it didn't go far enough, the insurance companies stuck around like barnacles, leeching off the medical industry, with the government mandating we do business with them and they do business with us. I say scrap the whole lot of them.

The rises in health care costs were happening long before Obamacare, and if anything Obamacare reduced the rate of rises or kept them at the same level.

We have chosen this to have high access, high quality care, while also choosing to reduce health with the way we subsidize our food system and force indolent lifestyle with car-dependent urban planning.

The best primer on the choices that make our healthcare expensive, and where the money goes, are in this video:

https://youtu.be/QqrpFICtqpQ?si=JOR3COojPD9iLn94

Unfortunately our national discussion of health care is not centered on the reality of the discussion, and is several levels of technical depth too shallow for us to have a public discussion that could reduce costs without reducing the care level for many peopl.

Those people seem incapable of considering that being surrounded by healthy people is a lot more enjoyable than being surrounded by the sick and poor. You don’t live in a vacuum. You interact with a lot of people every day, consciously or not, that probably earn less than you do, and clean your streets, wash your car, care for your elders and children, handle your food, serve your beer, and do a myriad of other things they can only do at good health.

That’s where those benefits go - to a functioning society where everyone gets a basic shred of dignity. Is it really so inconceivable to keep a little less of your disposable income in exchange for that?

https://penncapital-star.com/uncategorized/americans-suffer-...

> In 2022, UnitedHealth Group made over $20 billion in profit. Cigna made $6.7 billion, Elevance Health made $6 billion and CVS Health made $4.2 billion. All told, America’s largest health insurers raked in more than $41 billion of profits in 2022.

Universal healthcare is good. America's for profit system is bad. You have to get rid of for profit insurers (to start, lots of other changes need to be made as well, PBM and private equity ownership, etc). Is there will to do that? What is it going to take to get there? Every other OECD country has a functioning healthcare system, to keep the existing system in the US is a policy choice.

Edit: Absolutely wild to see the apologists who say, "This is fine." to billions of dollars being sucked out of the healthcare system as profits instead of being spent on care or reduced premiums.

Investors Are Pressing UnitedHealth Group to Deny More Care - https://jacobin.com/2025/06/investors-unitedhealth-group-car... - June 10th, 2025

Democrat senators probe UnitedHealth over nursing home care denials - https://www.healthcaredive.com/news/democrat-senators-probe-... - August 8th, 2025

Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers - https://www.theguardian.com/us-news/2025/may/21/unitedhealth... - May 21st, 2025

> UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found. Those secret bonuses have been paid out as part of a UnitedHealth program that stations the company’s own medical teams in nursing homes and pushes them to cut care expenses for residents covered by the insurance giant. In several cases identified by the Guardian, nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers. At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings and photo evidence.

As long as a profit motive exists, there will be incentives to reduce or avoid care for more profits.

I acknowledge I'm using anecdata and deliberately telling a story to pull at your emotions, but my cousin died suddenly at 45 of a heart attack, having been skiing and surfing just weeks prior, IE: seemingly great health. But, because he had been a (successful!) self-employed person but was in a bit of a bad time (wife cheated, divorce, sudden economic shift...) he didn't have health insurance so put off going to the doctor when he had a weird symptom a week or so before he passed.

I bring this up because in this country our health insurance is broken in every way. We absolutely should be investing in preventative medicine, because doing so would not only have found things like my cousin's situation, but it would also help us ward off both the disease and cost of more chronic illness. Instead most of us dwindle along with very limited access for decades until we either get some condition that forces us into very expensive and time-consuming care, or we end up gutting whatever life savings we might have on our last few months. So is an annual physical really all that big of a deal on the surface? No, but it's emblematic of how broken our approach is to care - to put it in IT terms, we have no monitoring/observability or metrics and we only take action after we've had an incident or breach, and even then we are generally only applying patches not dealing in RCA.

> being forced to buy insurance with a premium so high my risk adjusted return for self insuring is actually higher

This is how all insurance works though. Everyone pays in, and those unlucky enough to experience catastrophic problems get a way bigger payout than those who don’t.

Pooling risk is the entire point of insurance. Without that, it’s not insurance, it’s just a payment system, and those unfortunate enough to have big problems have to pay more.

Perhaps your views of what a society should be ‘for’ means you think that the unfortunate just having to pay more is fair, but I don’t.

>incompetent health care administration.

They're not incompetent. They looked at the laws and realized they get the same cut of a bigger number by bloating overhead costs.

> % required spending on actual Medicare care by health insurers (limiting administrative and marketing expenses)

That part stayed in. Note that this actually isn't relevant for most people get their insurance through an employer who self funds their plan.

https://www.cms.gov/marketplace/private-health-insurance/med...

Also they removed the requirement to have end of life care discussions ahead of time. Demonized as "death panels" by the right IIRC. Which was ironic given it would surely have saved a ton of money.

Yes, I don’t expect anything to happen during this administration, but who knows, maybe things will become broken enough later that something will actually happen in my lifetime.