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[Frumple]

I wonder who's REALLY responsible for the state of the healthcare system as it was before ACA was done?

Lots of people? Various politicians inclined towards opposing regulation (which are indeed primarily GOP ways, but not exclusively), the insurance companies being what they are and unwilling to mitigating its problems, our medical care being what it is and unwilling and/or unable to mitigate its problems (though I forget quite when some of the laws exacerbating that side of things came in), demographic and economic shifts making noticing or doing anything about problems harder, bloody minded inertia, etc., etc., etc.

Pre-ACA we were just kinda' not really trying even as much as the ACA does to make our healthcare system be worth a shit. Letting the market be the market, with bit of help from whoever could be bribed on the legislative side of things, the occasional tidbit getting in there when things went really badly. To the surprise of no one with a lick of sense, that lead to things going increasingly to shit.

... if you're talking responsibility, well, there's a lot of it to go around. The industry (insurance or otherwise) members complicit in doing all sorts of skeevy junk in the name of profit (shonus mentioned some probably a few dozen pages back, now, ferex), the politicians working to prevent anyone from stopping them, the ideologues that fornicated rhetoric into getting anyone to think either was a good idea, the voters that kept putting fucks in office that would cheerfully do so, the population in general that didn't get a fuckton louder, sooner, about the mess. Etc., etc., etc.

Bits and bobs among pretty much everyone, basically. Primarily all the shits older than about mid thirties to early forties, since they're what's living that actually had the means to do much of anything about it while the problems were building up and starting to kick into high gear, but it falls on pretty much all of us with any particular societal/political weight to varying degrees. It takes a village to screw over a hospital as badly as we were screwing up our healthcare. Not to say we're not still humping it with vigor, mind, but since a bit before the ACA and in the time since, we've at least been trying not to thrust with quite so much enthusiasm.

[EnigmaticHat]

I would honestly say the rot in American Healthcare comes from the American ideals themselves.  Us Americans try to run everything like a factory, in every possible meaning of those words.  In the case of healthcare, our debate is poisoned by the assumption that healthcare should be an engine of profit for private industries.  No one else in the entire world, not even kleptocratic Russia, thinks that way about healthcare.

Edit: To be clear, representing the interests of doctors isn't the poison, nor is private insurers advocating their interests necessarily toxic.  What's I'm referring to is the idea that free market capitalists have a right to optimize healthcare for their own profit.  That's just not how effective healthcare works and every other country one way or the other has seized or will seize control of the market to shape it as they want.  Private industries are allowed to participate in the market but not to run it, except here.  Well, prior to Obamacare, now with the ACA we have an unholy mix of both perspectives.

[Dunamisdeos]

Private industries are allowed to participate in the market but not to run it, except here.  Well, prior to Obamacare, now with the ACA we have an unholy mix of both perspectives.

Pretty much this. ACA was a step in the right direction, but now its worse for more people. Whether that's because of Republican interference or Democratic disconnect depends on who you ask, but I promise that my friends without insurance as a result don't care one whit.

They just want to not have to worry about how to pay for basic doctor visits. We are a first-world nation, what is happening. :/

[Egan_BW]

We are a first-world nation, what is happening. :/

citation needed

[Descan]

The problem with the American healthcare market is that it's not private in the right way, in that the people who pay for it either a) can't really choose where to go (individual people) or b) don't have much of an incentive to negotiate hospital prices down (insurance agencies; they'll either pass the cost off to the patient in the long-run, or they'll just not pay it, with some loophole or another.)

Instead of having a government run agency which has little-to-no profit motive, as close to perfect market knowledge as can be gotten (more than an individual, at any rate) can punish gouging hospitals where-as insurance companies (if they even care to) can only refuse to pay them, and can negotiate in good faith on behalf of the larger population. Same for with drug companies, too.

Having the doctors and healthcare *providers* be private market, individual people, works fine. It's how Canada (or at least, Ontario) runs it's healthcare, private practice and public payment. Keeps costs down, everyone involved is cared for, and there's very little bureacratic overhead for the government. We don't have that weird double-whammy cost like Americans do, where they pay more publicly for healthcare, and then can't even use it unless they pay privately on top, with the result that Americans pay a *lot* more for a *lot* less than anyone else running pretty much *any* system.

[Madman198237]

That sounds like naivety.

So much naivety.

There's no such thing as "perfect" market knowleddge any more than there such a thing as "no profit motive" in most government positions. There's ALWAYS a potential for corruption, and corruption usually has its roots in profit.

[Dunamisdeos]

Yeah I mean take a look at the USPS if you want to see the government's tactics on things it monopolizes and considers a source of income.

They've straight up barred private people from competing fairly when it looks like they are at a disadvantage, and they provide the absolutely basic minimum of service.

[Lord Shonus]

The USPS worked fine until the 80s, until pretty much all tax funding was ripped away from it and it was forced to be self-funding. It is also perfectly legal to "compete" with the USPS in most respects, with the only postal monopoly being on the delivery of non-urgent "letters" direct to mailboxes - something that is already nearly extinct except for advertising.

[Frumple]

Pretty much this. ACA was a step in the right direction, but now its worse for more people. Whether that's because of Republican interference or Democratic disconnect depends on who you ask, but I promise that my friends without insurance as a result don't care one whit.

... what? Last I checked it's the exact opposite of worse for more people. Number of insured have gone up since the ACA came into full effect (2014 or somethin', it hasn't really had teeth for very long) unless the world's flipped itself since the last time I looked at the numbers, and some of the fucked up exploitative things insurances companies were doing got taken behind the shed and shot. It's maybe worse for some people, but even some folks that outright lost their coverage came out better off due to the extent insurance companies were trying to sodomize people (not that they've stopped, of course, but at least it ain't as easy).

Unless you're talking the ACA itself after these years of GOP malfeasance, I guess. ACA is worse off than it would have been if most of the conservative side of congress and the executive branch had just retired and stayed home.

They just want to not have to worry about how to pay for basic doctor visits.

I hear that, though. Just don't even remotely get how they can look at the early 2000s and before and think that was an improvement. Plenty of people, myself and most of my family included, had insurance but effectively couldn't goddamn use it for much of anything except an excuse to piss away money on a monthly basis, and didn't have a chance in hell of being able to afford a plan that did sod all except major stuff (and gods know that shit was a crap shoot if it did come up, with how hard the companies tried to avoid paying out).

Ain't seen a soul worrying more about how to pay for a doc visit in 2017 than they did in the 90s, personally. I've been friggin' uninsured outright for a while now and still not worried any more, and less with some crap.

People still worry, but it ain't like they didn't before. Maybe they've forgotten the 90s (and I can't entirely blame them for wanting to on the healthcare front, really) or pre-ACA times in general, I'unno.

[Descan]

That sounds like naivety.

So much naivety.

There's no such thing as "perfect" market knowleddge any more than there such a thing as "no profit motive" in most government positions. There's ALWAYS a potential for corruption, and corruption usually has its roots in profit.

I'm not sure how you can say "That's naive!" to something that works for, at a minimum, 13.5 million people. That's only the population of Ontario, to say nothing of either the rest of Canada or the rest of the world. Like, if you don't actually know what you're talking about, please say so. Because going "how naive!" to a description of something that has been working for over 40 years now is... Well, naive.

I'm not even sure how stupid you have to be to think saying "There's no such thing as "perfect" market knowleddge" is a proper response to "as close to perfect market knowledge as can be gotten (more than an individual, at any rate)" but that is a doozy.

And the existence of corruption has *nothing to do* with government run healthcare. Yes, you can have corrupt governments. That corruption would be there regardless. You don't solve that by going "Fuck it, let the poor people die or go bankrupt!" you solve the root corruption. It's been done before, plenty of times, in a wide range of governments from local to federal and from poor areas to wildly rich areas. But profit motive is *intrinsic* to an insurance agency; it's *not* intrinsic to a government run system. Like, I'm really scratching my head on how to make that more obvious, it should be face-value obvious.

[Dunamisdeos]

I was talking about all the people I've actually spoken to who have described the way that their healthcare is worse after ACA. My parents' (who are not that elderly, mind you) situation is that they pay more for their care and depend on a government stipend to afford it at all, also they lost their primary care. They are in fact in debt now because ACA did not pay for the care that they would have gotten under their pre-ACA insurance. They are absolutely measurably worse off, and I have spoken to multiple people with this situation.

I also know folks on the lower end of the income spectrum who have to pay for insurance that does not cover their condition. That helps no-one.

Don't misunderstand me, I think that overall it is positive but far from what we need end-game. I have trouble fully supporting a thing that hurts so many people. We can't reduce healthcare to a set of scales where we have more people helped than not so hey, good job. People-as-numbers is how we got here, and I don't think It's a bad thing to admit that ACA needs improvement badly.

[RedKing]

Yeah I mean take a look at the USPS if you want to see the government's tactics on things it monopolizes and considers a source of income.

They've straight up barred private people from competing fairly when it looks like they are at a disadvantage, and they provide the absolutely basic minimum of service.

Yes, they've barred private companies from competing, which is why FedEx and UPS are almost out of business. Oh wait...

[Dunamisdeos]

Yeah I mean take a look at the USPS if you want to see the government's tactics on things it monopolizes and considers a source of income.

They've straight up barred private people from competing fairly when it looks like they are at a disadvantage, and they provide the absolutely basic minimum of service.

Yes, they've barred private companies from competing, which is why FedEx and UPS are almost out of business. Oh wait...

Now I don't want to lay down the smackdown as someone who works heavily in this industry, but that is a fallacious statement.

FedEx and UPS are barred from transporting official mail and selling stamps. They get around this by considering them as "packages". USPS has been unable to curtail private packages and don't provide basic freight services, which is what FedEx and UPS make their primary revenue on. They are the Unites States Postal Service, and there are exactly no other Postal services. They do packages on-the-side.

They have absolutely shut down previous attempts to get in on that sweet mail service. It's only recently that things like snail-mail have gone out of favor, hence the USPS always complaining and raising the cost of stamps and such. They even tried to get into this position on email when that came around back when, which was obviously intrinsically impossible.

I'm not in a place to post links, but the research is easily available if you're looking for examples.

[Reelya]

I was talking about all the people I've actually spoken to who have described the way that their healthcare is worse after ACA. My parents' (who are not that elderly, mind you) situation is that they pay more for their care and depend on a government stipend to afford it at all, also they lost their primary care. They are in fact in debt now because ACA did not pay for the care that they would have gotten under their pre-ACA insurance. They are absolutely measurably worse off, and I have spoken to multiple people with this situation.

That's not a meaningful argument. Here for example is a 2009 article, pointing out that health insurance premiums had increased by 131% since 1999:

Today, the average cost of a family health insurance offered by an employer is $13,375. That’s up 131% over the last decade—a period in which inflation rose only 28%. And one estimate says that if costs continue on their current trajectory, premiums will go up another 166% in the decade ahead.

So, before the ACA was passed they were predicting a total of 166% inflation between 2009-2019 (or costs going up 10% every year). That is the baseline against which ACA plans need to be compared. Just saying "i was paying less before" is economically illiterate. In fact:

https://ycharts.com/indicators/us_health_care_inflation_rate
The inflation rate for healthcare costs for the years since ACA was introduced are below the long-term average. Saying you're not happy with the ACA unless it magically pushes 10% inflation down to zero or negative seems like whoever said that just hasn't thought about it at all.

[Dunamisdeos]

So like, those are great numbers, and I am sure they are accurate numbers, but my parents lost their health insurance as a reaction to the requirements of the ACA. After that, the only insurance they qualified for was the ACA, and that did not pay for their medical needs. Your numbers are great but also don't pay for my father's health problems, which were covered before ACA.

To be blunt (sorry I don't like being blunt), the only "meaningful" argument is whether or not a life was shortened by ACA, and I don't think it's logical to say that not being covered under ACA and in needless debt is somehow better than not being covered and in needless debt under the GOP.

I'm not happy with the ACA because it is actively and demonstrably hurting people. The fact that it clearly helps other people does not make it acceptable, only better against a baseline that I think we can all agree was horrific. We need to push past the idea that "enough" people have basic healthcare and move towards something better than the ACA.

I think we can at least agree that the recent GOP attempts to simply blow it up will result in worse things for everyone.