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Comment by tomohawk | Hacker News Reader

Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans.

If they were really interested in making better, cheaper plans, they would roll back most of the ACA, eliminate the restrictions on buying across state lines (actually allow competition), and transfer the tax incentives for getting insurance from employers to employees.

Basically, all they had to do to make healthcare more affordable was to open up the Federal employees plan to everyone and transfer the tax incentives to employees. This was actually proposed by both major parties prior. It would have been about a 10 page bill.

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The experience with credit card deregulation should put the lie to the idea that selling across state lines results in meaningful competition and better products.

After the Supreme Court ruled that credit cards could be issued across state lines, the issuers migrated to states with the weakest consumer protections. As expected, this was followed by a series of abuses: credit card issuers would raise rates without warning, hiked late and overlimit fees, and buried key information in fine print to obscure the true cost.

It fell to the federal government to impose stronger consumer protections, via the CARD Act.

Much of the ACA was concerned with strengthening consumer protections by ending policies like rescission, lifetime limits, or denial for pre-existing conditions. If we were to repeal the ACA and allow selling across state lines, we should expect the re-introduction of these policies and worse.

The Federal plan banned those things long ago and yet still created a functional market that helped contain costs and boost quality. It still does today. Only, just for Federal employees and Congresscritters.

The real issue is the ACA is a solution from 60 years ago that doesn't meet the problems we have today and has actually made a bad situation worse.

It's a little offtopic, but this reminds me of Lessig's "the corrupting influence of money is the first problem facing this nation. That unless we solve this problem, we won’t solve anything else."

In my opinion the public option wouldn't have cost us much as a nation on the whole, and could have possibly worked out to great advantage, but was not going to happen because health insurance companies are too powerful for that sort of thing to get through.

> In my opinion the public option wouldn't have cost us much as a nation on the whole, and could have possibly worked out to great advantage, but was not going to happen because health insurance companies are too powerful for that sort of thing to get through.

The only public option that would have gone through would have been one that the insurance companies blessed, whereby there were the mediators of all the payments. Which is basically what we got.

If you solve the money problem you can solve a lot of problems, but until you solve the money problem few or none of the rest of these problems will get solved.

> In my opinion the public option wouldn't have cost us much ...

If you look at the margins the insurers are using (the maximum a public option might be cheaper), they're not much. 10% is rare. Given government inefficiency, I'd expect a public option to have been at least as expensive, and probably more expensive.

So why would a public option be cheaper ?

It varies significantly by state, but existing public options are similarly priced or cheaper in terms of cost per person than private healthcare.

https://www.cms.gov/research-statistics-data-and-systems/sta...

Where in the link does it say that?

Not the clearest source, I'll admit.

These are better, and show Medicaid spending roughly $5000/enrollee vs. roughly $8000 per capita overall healthcare spending in the USA in 2011 :

http://kff.org/global-indicator/health-expenditure-per-capit... http://kff.org/medicaid/state-indicator/medicaid-spending-pe... http://data.worldbank.org/indicator/SH.XPD.PCAP

>Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans.

and

>open up the Federal employees plan to everyone and transfer the tax incentives to employees.

Seem somewhat in contradiction. I'd go with the first being the incorrect part.

The Federal plan operates like a big market. Each year, you can change between plans from a menu of hundreds of plans. You can also see other people's reviews of those plans. Over time, plans that can't compete drop out. Other plans get better and service gets better in order to compete.

Prior to the ACA, health insurance was heavily regulated. You could not buy across state lines. You could only buy (affordably) within the plans offered by your employer. Individuals oftentimes couldn't even buy plans (for any amount) that were offered to groups. With the ACA, this is even worse, but that's beside the point.

Creating a single market with the Federal plan would have removed tons of anticompetitive regulation and enabled anyone, regardless of who they worked for or self employed or whatever, to buy a plan from that single market.

Moving the tax incentive to people instead of corporations would have allowed people to pay for those plans with pre tax dollars.

> eliminate the restrictions on buying across state lines

What's the law that prevents that? (honestly wondering)

> It would have been about a 10 page bill. It would never pass in the current gov't.

There's nothing that prevents companies from selling insurance along state lines - as long as they comply with the insurance regulations of every state they want to sell in.

See: http://theincidentaleconomist.com/wordpress/meme-busting-sel...

"Selling insurance across state lines" is a misleading way of saying that companies should be allowed to sell in a state without complying with that state's regulations, just the regulations of their home state. Given the example of how this played out in other markets (e.g. credit cards), a more accurate summary would be "remove state-level insurance regulation".

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