I've always disliked how right-wing parties automatically get to enjoy the assumption that they are "business-friendly". That's not the case -- their policies tend to be friendly to existing big businesses, but may be deeply hostile to new or merely potential businesses.
This list of founders who were able to make the leap thanks to ACA's safety net is a case in point. Under Republican policies, these businesses would not exist.
There is also the mantra that Republicans are the party of small government and fiscal responsibility. Nope, the difference between Democrats and Republicans is what they want to spend the money on. This is just a fact, easily verified by looking at the debt across decades of various administrations and congressional alignments.
A few years ago Ted Cruz and company very nearly shut down the government and defaulted on the national debt, insisting that raising it was irresponsible and laying it at the feet of President Obama. They insisted any increase in spending had to be offset by a cut somewhere else. Sounds like a really bold, principled stand. Then this:
Now that Republicans are fully in charge, they just authorized an escalating increase of the debt limit, running from $580B/year (2017) to $946B/year (2026), or a $10T increase over the next 10 years. There was no dissent, it was just quietly passed. I'm not saying it was wrong or irresponsible to do -- I'm just saying the politics are transparent, if they weren't already.
As a liberal-leaning person, I disagree with Rand Paul on many policy issues, but respect the fact that his actions are consistent with his stated ideals, which is becoming increasingly rare.
We also know for a fact that Republicans aren't in favor of the government staying out of people's private lives. They are, after all, strongly anti-abortion, which by definition is an extremely private affair.
edit: what I said is 100% correct, so I will assume that the downvotes are simply political in nature.
"We also know for a fact that Republicans aren't in favor of the government staying out of people's private lives."
I think it's pretty clear at this point that both parties love getting involved in the private affairs of individuals. Obama continued Bush-era spying policies, and in fact just this week (https://news.ycombinator.com/item?id=13390511) expanded the power of the intelligence community to snoop on Americans.
Blaming just one political party is demonstrable nonsense.
Democrats have never said they want the government to stay out of people's private lives. That's strictly a Republican talking point that goes in tandem with their criticisms of "Big Gubment".
> increase of the debt [sic] limit, running from $580B/year (2017) to $946B/year (2026)
Growing the deficit from $580bn to $950bn over 7 years means it is growing at over 6.2% per year. To be fair, the median nominal GDP growth rate between 1933 and 2015 was 6.4% [1]. That said, forecasted near-term growth is expected to come in between 2.5 and 3.5% [2].
The difference between the 6.2% deficit growth rate and 2.5 to 3.5% nominal GDP growth rate will need to be made up with a mix of tax increases (austerity), inflation (redistribution) or, while unlikely, default.
I see it as part of the DC bubble effect. What is considered "pro business" is defined by corporate lobbyists, what is "pro labor" by the unions with the largest bureaucracies, and so on.
> I think the GOP has yet to figure out what their health care policy even is. They really need to figure out how to be for something again.
I'm not sure what the policy is, but I know they don't have a plan. I can't find the link, but I heard a spot on NPR (either Fresh Air or Here & Now) talking about the plan to repeal the ACA. The purported goal was to vote immediately to repeal it but delay the effective date. There's no plan. In the mean time, they're supposed to figure it all out.
I really think the GOP needs to go with evidence based policy analysis. If they think they can come up with a better health care system, fine, but what are the metrics for better? health care costs have gone up way past the amount of inflation, and to some extent that makes sense, because there are new treatments, but it seems like tax breaks are not going to help the working poor to the same extent that the ACA subsidies and medicare expansion do.
> They are for free market radicalism. It can hardly be considered "conservative" but it is certainly for something.
Neither party is really in favor of free markets in any meaningful sense. The GOP happens to use that rhetoric more than the Democrats do in order to gain support for their policies, but knowing how to leverage the rhetoric doesn't mean that's what they actually support, if you look at their actions.
These problems are all a result of the huge tax benefit given to employer-provided healthcare; if we got rid of that or extended it to apply to individual plans as well (and hopefully allowed people to purchase out-of-state insurance), it would reduce costs, and allow for more job freedom.
I would also personally rather have health insurance actually act as insurance, where you are granted the coverage at the time of diagnosis, rather than having the insurer gradually pay for treatment, but this is unlikely to come to pass.
Insurance is a terrible model for health care. Everyone needs health care. Insurance only works when you have a large pool of persons paying premiums against an at-least-relatively unlikely risk. That might work for things like cancer, but it doesn't really work for anything else.
We should not have to have an insurance policy for a doctor check out that weird lump on our thigh or come in and spend 10 seconds pretending to talk to us before scribbling out a prescription for something that vaguely sounds appropriate and walking out.
Insurance is what distorts these markets. Patients need to pay doctors directly again. Real competition needs to be returned. Right now, the doctor inflates their bill 5x because they know the insurance is going to talk them down, the insurance talks them down because they know they're going to inflate the bill and not worry about it since it's an insurance company paying out, and round and round we go.
There's no reason the market for medical care needs to be different than the market for food, which is cheap and abundant. People often say that you can't can have an efficient medical marketplace because medical care is emergent, but that's usually not true; most medical care, like most meal times, can wait long enough to allow the patient to make a choice between competitors, and providers who charge more than the average demographic in their area can afford will go out of business.
The incentive to overcharge for emergent care is countered by the incentive to compete, which has already lead to many "urgent care centers" arising throughout the U.S. Good government regulations that prevent cartels from organizing and causing the markets to freeze up/fail can help. These regulations should include outlawing medical insurance.
Whatever the solution is, the current situation is an abject failure. ACA band-aids a couple of warts but it gave us new wounds in the process. Whole thing needs to be torn down and rebooted based on sound market principles.
A tax benefit works only if the person has income to offset. If you are a freelance developer and you get sick with a life threatening or chronic illness or even just injured, you may not be able to work while you are getting treatment. If you want more job freedom, a needs based subsidy based on tax income allows cost shifting from years of productive work and tax earnings to years where you can't work, even if your productive work comes later in life, after treatment.
It also provides for those who may never be able to earn enough working to pay for current health insurance, those who are retraining latter in life, and those starting a company.
If I were campaigning for something similar to what you describe, I might sell it as a refundable tax credit, which would be no change for people with employer-provided healthcare, and a benefit for the unemployed or self-employed.
The FDP (Free Democratic Party) claims to go for liberal rules so businesses can strive. Somehow this mostly includes rules for big corps, with the remark that they provide employment.
Funny thing is, the head of FDP is a guy who burned about 3,4M€ of investment money and federal credit.
There are always parties with nice ideas, but when you see who donates money to them, you understand why they can't realize them :\
The ACA increases the opportunities for young people and people with chronic illnesses. By distributing those costs, healthy individuals pay more in premiums, which limit their opportunities. If we are optimizating for overall economic productivity, far more people benefit from not having the ACA.
Virtually all economic growth comes from small businesses and startups. If we're "optimizing for overall economic productivity", we should be bending over backwards as a society to make it as easy as possible to start businesses! The existing employer-provided model strongly discriminates against small businesses and startups. Providing insurance to employees is both a cost and a bureaucratic overhead. Big corporations have much more negotiating power and can get better prices than small businesses. They have much more staff and can afford dedicated HR staff to deal with insurance.
Moreover, in the case of expensive or catastrophic coverage, society is picking up those costs anyway (or alternately, just letting people die). Your premiums then go to cover the costs of people who wound up declaring bankruptcy. And no insurance (or bad insurance) cuts into preventative care that can detect problems early, when they're much cheaper to treat.
I support the ACA (or better yet, much more socialized models) because I want to optimize for overall economic productivity.
My point is that for the median entrepreneur or small business owner, the ACA made it harder. Increases in premiums are not trivial.
I agree an employer based model does discriminate against startups, but my point is that the ACA also makes it harder for the median entrepreneur to succeed. The fact that the fringe cases can start companies does not to me justify the drain on all other entrepreneurs.
Hear, hear! Moreover, if we somehow create a law to limit people's age so that they die at 40 (obviously without any kind of pain), the premiums would be really affordable for those who really deserve it because at 40 is when health costs for even healthy people begin to ramp up.
You really don't understand how insurance works, do you?
People pay into a pool and if one day they too become ill they'll need to draw on that. Prior to the ACA it was in the best interest of insurers to simply eject all the "sick" people from the pool. What use is insurance if when you really need it they cut you off?
This hurts everyone. It's not about paying more in premiums. It's about insurance that sticks around when the shit hits the fan.
I'm not sure it is or will work that way, in practice - the more preventative care, less emergency room part, anyway.
The total cost of my health insurance premiums is about 20k/year; some of this is subsidized by my employer. I have a $4500 deductible. The insurance does not pay for anything, outside of preventative care, until I've paid $4500. After that, they contribute 80% up to some number, $7500 I think, and then they contribute 100% until the end of the calendar year.
Because I have such a high deductible, and due to the opacity of medical billing, I am not going to the doctor unless I'm pretty sure that not going to the doctor means I'm going to be put out of work or going to die. "Preventative" care is defined very strictly: you get a physical. For example, "preventing" the development of pneumonia by treating your respiratory illness early does not count as preventative care.
The best I can do is squirrel away what I can in my HSA...but that's one health catastrophe from being blown away. God forbid I come down with any kind of chronic illness that lasts longer than the calendar year.
That said, for the poor population, this is definitely true - Medicaid is a dream compared to private insurance. At least in my state, if you're on Medicaid, you don't even see medical bills. It's really lamentable the states were allowed to turn down the Medicaid expansion - the expansion of public health insurance was the best part of the ACA, in my opinion, and the most regrettable part of the bill is that the public option is not available to everyone.
About $7500. I would be surprised if your costs are radically different - be sure to account for any employer or government subsidy for health insurance premiums.
Also, those numbers include only in-network providers. If I am given out-of-network care - which isn't always under my control - then I could potentially be on the hook for tens of thousands more dollars.
But the concept of in-network and out-of-network coverage isn't a new to the ACA, or that different. There are plans with national network coverages - so why are you going out of network?
I wouldn't deliberately, but there are plenty of situations where someone might inadvertently be given out-of-network care.
- An out-of-network providers gives you medical attention at an in-provider facility - maybe your ER doctor, surprise, is not in-network, even though the hospital is in-network. [1] [2] [3]
- Maybe you have a medical emergency and the closest facility at the time is out-of-network. (In some states and with some insurers under some circumstances, you can get them to pay the difference for emergency out-of-network care.)
The biggest risk factor is the "normal" <= $7500 medical bill from an in-network provider, but inadvertent out-of-network care is still something you have to be concerned about.
Also, I'm not sure if I'm reading you right, but "in-network" does not necessarily have anything to do with geography - sure, there exist in-network providers for my insurance throughout the country, but the second-closest hospital to me is still out-of-network.
EDIT: The HN backoff must be crazy high - 40 minutes later, and I still can't post, and I'll be offline the rest of the day.
Because the ACA didn't fix it. From my perspective, it was largely a giveaway to private insurance companies with some fortunate side effects.
The total cost for my health insurance premiums are 20k a year.
My in-network deductible is $4500.
My in-network out of pocket is $7500.
My out-of-network out of pocket is $20k.
Those are not hypotheticals, and because of those costs, I avoid medical care unless it is absolutely necessary. I'm afraid we're getting into the weeds - my main point is that the ACA's preventative care provisions are really quite weak and don't mean what we might think they'd mean; the preponderance of high deductibles and out-of-pocket maximums mean that people will continue to avoid getting prompt medical care until their condition becomes serious. The preventative benefit, mainly, is that everyone gets a yearly physical and a few other narrow types of preventative care.
> Not when you factor in more insured people means less expensive medical costs - i.e. more preventative care and less emergency room visits.
Well, you can make the argument for preventive care on medical grounds or even moral ones, but you can't say it actually saves money. When people have access to preventive care, they also tend to consume more, which means greater costs (although better overall care)[0].
This has borne out with the ACA[1], as the data shows that preventive costs increased faster than chronic and acute care costs dropped, by a very significant margin.
You should really read articles before you cite them, because neither use data after 2014, when the ACA provisions took effect.
The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen, and that medical prices have not risen more than inflation.
> The ACA report last month shows the opposite of what you're saying, that oupatient costs have dropped more than inpatient costs have risen
That's not actually the opposite of what I said. Outpatient vs. inpatient isn't the same comparison as preventive vs. responsive care. You're comparing apples and oranges.
> You should really read articles before you cite them
From the Hacker News guidelines:
> Avoid gratuitous negativity.... Please don't insinuate that someone hasn't read an article. "Did you even read the article? It mentions that" can be shortened to "The article mentions that."
The majority of outpatient treatments are preventative healthcare, e.g. check-ups, x-rays, rehab, minor procedures, blood draws, etc.
The majority of inpatient treatments are responsive healthcare, e.g. emergency, major surgeries, ICU/NICU, burn unit, etc.
Also, when you present an article as a source for something that it is not, then it is valid to question if you read it and present why, like I did. The full sentence of what I said is valid by HN rules, even if you attempt to quote it out of context:
>You should really read articles before you cite them, because neither use data after 2014, when the ACA provisions took effect.
I'm well aware of what ambulatory care is. But not all ambulatory care is preventive care; in fact, the majority is not, which is directly contrary to your previous claim.
I'm not sure to what extent that factors in productivity improvements from workers with better health though, in terms of overall economic activity and GDP.
Distributing cost will improve economic vitality if it removes critical obstacles for others while not substantially impacting the opportunities available to the rest.
Without ACA, a software engineer with a chronic illness wouldn't be able to start a business. Meanwhile, a healthy software engineer will start a business regardless of ACA because a minor difference in healthcare premiums is not material to that decision.
This list of founders who were able to make the leap thanks to ACA's safety net is a case in point. Under Republican policies, these businesses would not exist.