ACA is horrible for the middle class. The only reason it retains any type of popularity is because the media refuses to associated ballooning cost to cost redistribution that it enables. Preexisting conditions? Middle class family picking that up. Subsidy? Middle class family picking that up.

And this is precisely why nothing will ever change. I tell everyone who will listen to me on my soap box, we will never get universal healthcare until we divorce healthcare from employment (by that I mean, make it to where businesses cannot offer benefits at all).

Personally, I would retire early. I have enough to cover bills and reasonable HC costs, but the way it is now, I'll just keep plugging away for a few more years.

I also think about people stuck in bad relationships they'd otherwise leave.

Then you should consider emigrating to a country with universal healthcare such as Canada.

I was wondering one day why it seemed like so many YouTubers were Canadian.

The "well of course" moment took me a day longer than it should have.

Part of the reason why there is no effort to fix this, to keep you a slave to a job that provides healthcare. Imagine the reduction in labor supply and increase in labor costs if healthcare did not require employment. On can, in many cases (facts intensive), bail to a developed country with healthcare if you want to realize this dream earlier than whenever the US will achieve the outcome (and your life situation supports doing so). It could potentially takes years, if not longer (~5-10 years), for the US to fix healthcare as the situation continues to degrade for those who need affordable healthcare today.

https://news.ycombinator.com/item?id=47161587 (expat resources for those potentially interested)

https://relocateme.substack.com (a product of andrewstetsenko here, no affiliation, I just like resources that can help humans achieve their success criteria)

https://healthcareinfusion.org/ (for healthcare workers interested in Canada, likely does not apply to many here, but please share with others who might be seeking a path)

(i see this problem as a vulnerability management and exposure exercise to attempt to solve for, ymmv, no affiliation with any resources recommended)

I think it's generally gotten better for insurance companies, at the expense of both end customers and providers (with the exception of providers that have vertically integrated into the ecosystem, e.g. Aetna/CVS, etc. to capitalize on the advantages that brings).

Not debatable that it has gotten worse over the last decade, mostly due to one party in the government intentionally doing what they can to chip away at the efficacy of the program, which when it launched was incredibly compromise heavy and should have been viewed as a first step towards a better, long term solution.

I had a local primary care I really liked; I never saw the Dr. there, just the Physician's Assistant typically. They were independent, and last year they made the change to go to a membership model. Basically $50/month just to be able to be a patient of their practice, and then use your insurance for care. In their notification she laid out the economics of where they currently were and it wasn't sustainable for them, based on how much they were squeezed, mostly by not being also a facility to be able to double bill insurance for facility fees + care fees. Also mentioned that the other 3 independent doctors in our neighborhood had all closed in the last 2 years.

Out of curiosity what state are you in?

> Who is it better for?

People with pre-existing conditions. They were literally uninsurable before the ACA.

The insurance costs are also skyrocketing in the employer-sponsored insurance.

ACA premiums are literally taxes, the price you pay has nothing to do with your health risks.

You are paying more because a lot more healthcare is being delivered, to people who never used to either due to exceeding maximum benefits (we have the opposite today with out of pocket maximum), or being denied for pre existing health conditions.

So to answer:

>Who is it better for?

My 4 year old, who has received hundreds of thousands of dollars of cancer treatment, and will need a bunch more over the coming years.

Without the ACA it would have been even worse. And by worse I mean that even if the premiums were lower, we would still have horrible limitations like maximum lifetime coverage amounts or exclusions for pre-existing conditions.

There is a legitimate shortage of physicians in many areas, especially in primary care. This has a variety of causes including bottlenecks in the training pipeline, shitty working conditions that drive experienced doctors out of the profession, and an aging populace that has drastically increased demand. More and more doctors are opting out of taking any sort of insurance and shifting to concierge medicine or cash-pay models.

Yeah, since the ACA my coverage has remained the same while my costs have risen 10x; I'm in my 30s and my medical insurance costs 3x what my mortgage costs, and I still have $$$$ sized bills after a round of strep throat.

I would really like to just be able to get a true catastrophic policy which would cover unlikely risks such as cancer -- and then go on a cash basis for common meds and treatments. The ACA made this kind of insurance illegal, so my choice is to leave my family uninsured -- or let insurance soak up the money I might have saved for their college education.

Your blame is misplaced. Costs are increasing in spite of the ACA, not because of it. Pre-ACA your family insurance policy was likely worse in some key ways: it probably excluded coverage pre-existing conditions and had a lifetime maximum coverage limit.

So you support single payer where none of that exists?

Yep. We were promised it would save us money. Instead, healthcare care costs skyrocketed thanks to Obamacare.

No it didn't. The ACA slowed cost growth, which was already skyrocketing by the time it passed.

I don't believe you. It wasn't the "same plan". I guarantee that the plan you had before the ACA had a lifetime benefit limit, perhaps as low as $1M. Read the fine print. A single complex episode of care could easily blow past that limit and leave the plan member functionally uninsured.

Would you have been able to keep your plan under the system before ACA? There’s a lot of context missing in your comment.

I'm curious as to how your experience actually using the plan for more than preventive coverage? IIRC, plans before the ACA had a ton of customer unfriendly provisions which made the insurance far less usable in practice. E.g. denying coverage for preexisting conditions.

There was never a guarantee that you were going to keep your plan anyway, was there? Insurance companies are changing plans from year to year.

> I will never understand why people think ACA was so great.

I would never have healthcare without it due to pre existing conditions from childhood. I literally was going to be locked out of healthcare barring becoming wealthy enough to afford everything out of pocket until it passed. And that’s really wealthy not just software engineer money. I know a lot of doctors are offering routine services for cash at a discount in increasing amounts but if you need anything with a hospital or a specialist it’s a nightmare to even find out the price before agreeing to the service.

I don't know that "inclination to judge" is a necessary component of religious charity. Religious charities beyond healthcare give out a lot of "free shit no questions asked," and usually without any attempt at proselytization. Catholic hospitals are not known for turning down patients due to moral judgements.

If there's a benefit to religious charity, it lies not in the "inclination to judge" but in maintaining a multiplicity of authorities. Combining everything under the government umbrella gives you a totalitarian society; a liberal democracy restrains the power of government while allowing for competing authorities in other spheres, like medicine, religion, academia, and the press. Giving the government the power to mandate or withhold medical treatment for political opponents (think Soviet "sluggish schizophrenia" as a diagnosis for removing dissidents from public life) seems more worrying than strippers getting free healthcare.

Where is the problem here? Religious charity exists in places with universal healthcare.

Your linked to article does not demonstrate what you claim it does. Your reasoning is wrong.

Medicaid expansion was a big part of the ACA.

> An expansion that has almost nothing to do with the rest of the ACA.

That's a very strange assertion, it's literally "the ACA medicaid expansion" and was a key part of the whole thing.

I'm saying most political argumentation is dishonest and not intellectually rigorous, and that's what the comment was doing. It wasn't arguing based on facts or data or actual specifics, but rather according to vague political ideologies.

That's one reason that I believe politics are discouraged on HN. It turns off our brains and we start using less interesting or useful ways of thinking.

"Saved lives" or "Could Save Lives" is a ridiculous, un-falsifiable, and unprovable claim.

First, it involves twisting correlation and causation into an Escher knot. Secondly, it's not even what cited source says.

Yes, "reduced mortality along a timeline for a certain demographic" is a good and desirable statistic, but there is no way that it translates into the self-aggrandizing and sensationalistic "ACA/Medicaid saved tons of lives" (whatever "tons" is supposed to mean, in terms of lives. Perhaps grossly obese people died less.)