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[Reelya]

Sure ... but you need to compare "current situation" to the non-ACA prediction that the $13375 average family plan in 2009 would be heading towards $35,500 by 2019 (which is what increasing by 166% entails). If affordable care was already an issue for your dad, then I don't see how it would be much less of an issue under that scenario.

[EnigmaticHat]

^this^  Without the ACA, health insurance premiums would be even higher than they are now.  For everyone.

Anyway, the point I was making about healthcare wasn't that we need 100% taxpayer funded and government run universal healthcare with all private services barred.  The point I'm making is that an effective healthcare system aims to provide universal healthcare at the highest effectiveness and lowest cost.  This is true even if all of the actual services are top-to-bottom run by the private sector; the government will still find ways to regulate things to achieve the desired result.  An effective system isn't designed to allow private sector healthcare professionals to make as much money as possible, its designed to pay them as little possible.  Because the country itself is the client.  If the private sector is allowed to negotiate directly with citizens in an unregulated fashion, they hold all the power.  For individuals its not a viable option to say no to a treatment they require.  On the other hand, if the government is the one negotiating, they can use access to the citizens as a bargaining chip.  You take our terms, or you don't do business in our country.  Those terms of business are defined differently in different systems.  In some systems, there's an automatic free health insurance plan for all citizens, and the government hands out healthcare contracts in the same way the military contracts weapon manufacturers.  In other systems, like Obamacare, private insurers are simply required to provide a price point and level of service the government finds satisfactory.

Its not about ethics, its just good negotiating.  Even the harshest dictator could see that.  The truth of the matter is, a death in a society effects everyone else.  Each death is a drop in the bucket, sure.  But even the most mustache twirling, sociopathic rich person has to admit that on the national level there's a practical need to keep poor people alive.

Think of it like this.  Let's say we change our laws so all hospitals can turn people away from the ER if they don't have insurance.  Okay, homeless person gets stabbed, goes into ER, get's turned away.  Someone still has to get rid of the body, and what does that cost?  Money.  Money from the hospital, money from the government.  Same principle with workplace benefits.  If someone is fired because of an injury or illness they can't afford treatment for, that means a new employee has to be hired.  That costs money, and in the meantime, worse service for the customers.  Oh, the company is required to give out full time health benefits?  Still costs the company money, still wouldn't if we had affordable universal healthcare.

There's this great thing I remember someone from Sweden saying.   "We don't have all these benefits because we want to help other people.  We have them because we want them for ourselves.  We're selfish like that."  Not saying that's necessarily MY perspective, but the point is the US attitude towards healthcare benefits absolutely no one except health insurance providers and pharmaceutical companies.  Even doctors and hospitals are harmed more than helped by our system.  Even from a selfish and/or individualist perspective our system is awful.

[smjjames]

I'll agree that perhaps banning all private insurance stuff (though you said your parents were under the Government insurance Dunamisdeos? That shouldn't be affected, I don't think.) from operating outside of the ACA was a mistake and we can all agree that things could have been implemented better, like the whole "You can keep your doctors! Oh wait, nope!" thing for people under private plans.

I get that the ACA caused problems for your family, but I have no idea how much of a minority you're in. There should be some comprehensive study into what went wrong with the ACA for them. I know there have been plenty of surveys, but a comprehensive study would get deeper into the problems.

I wonder if one hangup that conservatives have with universial healthcare (and variant terms of it) is that they don't realize that it's possible for private companies to operate under it even if the government controls the market. I'm sure theres plenty of examples in the US where the government controls the market of something and private companies still operate.

[sluissa]

The ACA was basically a bandaid plan that would have worked to hold over things for about a decade and gave people a chance to work on a real solution.

The problem is instead of coming up with a workable real solution, we've spent the last decade arguing whether we should rip the bandaid off or not.

It is better than what was... but that doesn't mean it was a sufficient end point. Even with the ACA in place the whole system is going to fall apart, ACA just forstalled that for a bit.

[EnigmaticHat]

To be clear, I don't want to argue with anyone who had a bad experience under the ACA that it didn't happen.  I believe you that something bad happened to your family, and its terrible that it did.

All I'd say is we couldn't have gone on under the old system.  Something had to change eventually.  I believe that the right path is to go further along the path the ACA set, rather than go back.  And I think a lot of the badness could have been avoided if the national medicaid standardization/expansion hadn't been struck down by the supreme court.

[redwallzyl]

A lot of the problem is Americas obsession with the ludicrously distorted definition of freedom and fairness. Everything is framed as on of those but a lot of the time its just a shitty illusion of fair like flat tax. I don't know what this thing is with people going fanatical over shit that actively hurts them just because some politician slapped the freedom label on it. The sheer amount of cognitive dissonance going on in America is staggering. but saying it make people start to claim your biased. well as it turns out its very possible to hold objectively wrong opinions you don't get to claim bias when I say your position is wrong just becasue its held by a party when your party gleefully says bullshit. I fell like if republicans said the sky was green and you said that was objectively wrong people would accuse you of bias. that's the level were on.

[Max™]

That Roy Moore guy said something about "towns in the US under sharia law" and when called out on his bullshit said "well I don't know which ones, I just heard that they were, but even if they aren't we don't operate like that here in the US, and I heard that they were anyways" so we can now expect some douchey Trumpists to come up with "Roy Moore said there were towns under sharia law in the US and I think that's terrible" and ignore anything to the contrary because they like wrapping up in a cozy blanket of dumbfuckery.

[misko27]

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.

God, please, spare us.

Here's a sincere question that I am shocked has not already been asked: is the state of Healthcare, right now, so horrifically bad that it is worth the cost (in time and political will as much as money!) spent hammering out a new system, muscling it through a hysterical Congress and a bipolar President, and spending years implementing? Can we not imagine anything else more pressing that Congress could be doing? Or is the state of healthcare so utterly catastrophic that Congress repeatedly flinging itself unto the spikes of legislative failure for over six months is actually worth it? Democrats want to introduce single-payer, a massive shift in Healthcare; why?! was implementing Obamacare not sufficiently painful? Republicans want to simply gut the whole damn thing; why?!? Is it so god-damned horrible that pulling the rug out from everyone is necessary?

I'm sure everyone here can provide personal examples of the current healthcare system not working, but I bet that if I asked you all "what do you think is the most pressing and urgent issue that should be addressed by Congress?" you would still be unlikely to rank "reforming/repealing/replacing/whatevering Obamacare" at the top. Healthcare needs (further!) reform. Of course it does. So does everything else!

That Roy Moore guy said something about "towns in the US under sharia law" and when called out on his bullshit said "well I don't know which ones, I just heard that they were, but even if they aren't we don't operate like that here in the US, and I heard that they were anyways" so we can now expect some douchey Trumpists to come up with "Roy Moore said there were towns under sharia law in the US and I think that's terrible" and ignore anything to the contrary because they like wrapping up in a cozy blanket of dumbfuckery.

I have very mixed feelings about such a person winning. On one hand, the Republican establishment tried very hard to make him lose. On the other, they had a pretty damn good reason to.

I guess the GOP Civil war has entered a new phase. Trump supported Moore, and the fact that the combined efforts of the wealthy establishment and Trump's personal popularity in Alabama was not nearly enough to stop Moore is a sign that there are more primaries to come.

[Reelya]

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.

I'd like to point out that this is exactly how a market-based approach to pricing works. e.g. if there aren't enough doctors for the number of people who want them, then the price of that procedure rises, until the demand for those medical services stabilizes with supply - because enough people who needed the procedure decided it was too expensive. It's a bidding system, basically: that's how a market works.

"In theory" the system will then expand doctor supply, although only to the point that this increases profits, so you never get a situation where they expand supply to the amount that everyone can afford to get treated. Total profits would be lower if the price was either too low (everyone treated) or too high (nobody treated). However, on top of that, doctors themselves (as a group) will always oppose any expansion in doctor-supply, since they get paid per procedure, so basically everyone as an individual in the industry is incentivized to oppose supply-side expansion of medical access.

Even if you have a HMO: they're bartering with providers, and if they decide that providing a specific medical treatment moves them away from their optimal profit-point, then they'll just deny it to you outright (they're willing to piss off customers if the churn cost them less than the treatment). This is why only a universal health insurance system can ensure that everyone has access to the procedures they need, even in theory. A universal coverage system is trying to optimize things so that it has zero% profit (no profits and no losses) and maximum coverage, instead of trying to maximize the total profits extracted.

[EnigmaticHat]

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.

God, please, spare us.

Here's a sincere question that I am shocked has not already been asked: is the state of Healthcare, right now, so horrifically bad that it is worth the cost (in time and political will as much as money!) spent hammering out a new system, muscling it through a hysterical Congress and a bipolar President, and spending years implementing? Can we not imagine anything else Congress more pressing that Congress could be doing? Or is the state of healthcare so utterly catastrophic that Congress repeatedly flinging itself unto the spikes of legislative failure for over six months is actually worth it? Democrats want to introduce single-payer, a massive shift in Healthcare; why?! was implementing Obamacare not sufficiently painful? Republicans want to simply gut the whole damn thing; why?!? Is it so god-damned horrible that pulling the rug out from everyone is necessary?

I'm sure everyone here can provide personal examples of the current healthcare system not working, but I bet that if I asked you all "what do you think is the most pressing and urgent issue that should be addressed by Congress?" you would still be unlikely to rank "reforming/repealing/replacing/whatevering Obamacare" at the top. Healthcare needs (further!) reform. Of course it does. So does everything else!

Our healthcare system is horrifically expensive and embarrassingly bad.  We've talked about the human costs enough in this thread so I'll just talk money.  The US military is ludicrously well funded, I *believe* having more money in it than the entire rest of the world's military's combined.  This is fueled by the "iron triangle" of the military, congress, and lobbyists all working together to keep our military spending high.  They've been long blamed by many people for a variety of America's ills.  Just keep this in mind for what I'm about to say next.

US military spending: 600 billion.  US government healthcare expenditures: 1 trillion.  US healthcare costs paid for by private citizens: 3 trillion.  We are paying almost 7x as much for healthcare as we are for our military, which is itself ludicrously expensive.

Per head, this is how we compare to the rest of the world:

Spoiler (click to show/hide)

Or close enough, pretty much any source should say roughly the same thing

Notice that in exchange for this, Americans receive a much lower level of care.  Our life expectancy has been increasing at about 50-80% the rate that it has been increasing in other developed nations, we have less facilities and less doctors, and those doctors we do have are inefficiently distributed with too many specialists.  In spite of all the private money spent, many Americans can't or don't get medical help because of financial concerns.

The American system is also extremely biased against the poor; we have a disproportionate amount of our spending as private, meaning the financial burden is put equally on the poor and the rich.  The US tax system directs sales taxes and social security, which are basically flat and the only taxes truly paid by the poor, towards healthcare and military expenses that do little for them personally.  While meanwhile directing property taxes (the form of tax disproportionately paid by the rich) towards local schools that will benefit their own kids and no one else's.  As a result, the poor pay through the nose for shit that is absolutely useless to them while the rich pay almost nothing into the healthcare pool yet get to be the only ones that directly benefit from their own personal tax payments.  Medicaid and social security in particular still force private citizens to pay out of pocket, yet target groups of people who cannot increase their income to actually pay for expensive procedures.  Retirees because they presumably don't work, and poor people because if they make more money they lose medicaid.  And of course in a global economy, how do you increase your income?  Education, the one thing all those taxes the poor pay doesn't actually get them.  Thus any procedure that is sufficiently expensive is largely off limits to anyone who doesn't have a full time job.  Which of course, the big reason no one has those any more is because anyone with a full time job in the US has to be provided medical benefits paid for by the employer, so that's another huge economic problem.

Basically?  Our healthcare system fails to provide healthcare, and if we were to reform it right now to match the OECD average in both cost per person and care per person, we wouldn't have a deficit.  The debt would go down every year.  Healthcare reform is the single most urgent issue facing the US bar none.  If left unchecked, the economic and social damage that our healthcare system causes could singlehandedly end our status as a superpower.

Edit: OK that last statement may have been slightly hyperbolic.  Healthcare deserves the majority of the blame for our economic downslide, and that could singlehandedly cause us our superpower status to quietly fizzle out.  So I guess a more accurate statement would be "healthcare, education, military, and prisons could eventually end our status as a superpower, with healthcare taking over 50% of the blame."

[scriver]

a sign that there are more primaries to come.

Wait, is the US entering election season again already? Jesus.

[Reelya]

Well there are a small number of special elections happen in November 2017, e.g. due to people who retired or got new positions, so not many running this year. That Roy Moore guy's primary win is related to a senate seat vacated by a Trump appointee, so it's not a normally scheduled election.
https://en.wikipedia.org/wiki/United_States_elections,_2017

but then next year they have the elections for the full congressional and 1/3rd of the Senate, plus most of the states governors have their elections. So arguably a bigger deal than the Trump election. People were already positioning themselves for the 2018 run a couple of months after Trump's inauguration.
https://en.wikipedia.org/wiki/United_States_elections,_2018

[martinuzz]

Twitter wants to increase from 140 to 280 characters. This will effectively double the power of the Trump. The world is doomed.

[sluissa]

@misko27

While I hate to have to choose my issues, my two top issues have been, and continue to be healthcare and the environment. The rest of the world does seem to be seeing the light on the environmental front, and even the oil companies are starting to realize "Oh shit, we can't lie to them anymore." And healthcare is a problem now, that we have solutions to now, that we can fix now, if we just get our collective heads out of our asses now.

So yes, I would say healthcare is currently the most pressing issue to me. Just personally it's currently the thing that takes the single largest chunk of my income, even beyond taxes, even beyond bills and living expenses and rent. I pay more for health insurance than anything else in my life, and beyond some routine dental checkups, and a couple of physicals(which I still had co-pays for), I've never even used it. But still, it's vital to have it there because even though the deductible would bankrupt me and put me into debt, it's still better than the debt I'd incur without it if I had some catastrophic illness.

That's not even to mention all the people I personally know who got screwed over one way or another by the current health care system. People who I know who have relatively good health insurance and finances but still get saddled with thousands of dollars of bills because they just happened to need an overnight stay in a hospital. People whose families have come to silently resent them for living, and ruining their finances, instead of dying and putting out a life insurance payment.

It's what keeps my mother working at a job she hates, despite being able to retire in other aspects, she's not to medicare age yet, so she has to keep working to afford insurance. (Insurance that used to be a free perk of her job, but is getting more expensive and covering less and less each year.) It's what made my father take a second job after he retired from his first, because he was still a few years from medicare and insurance would have been about 1/3 of his retirement check. (Luckily he's in it now, and fully retired.)

This shit literally keeps me up at night sometimes. A minor ache or pain will spiral into an anxiety fest of "Oh god, what if this gets worse or is serious and I have to go to the hospital." Despite the fact that some people are fine, some people are well off, a lot of people aren't. And it's a simple lottery to decide who gets screwed next with an illness or an accident.

So yes, Misko... health care is a big fucking deal.

[wierd]

Saying that trump is "a man of few words" does an injustice to reality; Saying he has a small vocabulary, with poor literary skills and a lack of imagination would be more accurate, but would go over the twitter limit.