If you're saying the ACA harmed the health care system, strong disagree. Again: the cost increases you're talking about were a fact of life before the ACA. There is no evidence that your costs would have leveled off without the ACA, and substantial evidence that the opposite would have happened.
That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just ignoring the math.
We haven't needed the coverage for two years but when we did, what we needed wasn't covered so we paid full price anyway including $80 for a bottle of Ibuprofen that was casually offered to us. The markups are almost criminal.
For a $1M home you can find insurance for $1,500 per year. It's exponentially less expensive.
ACA was the worst possible compromise to a serious problem. A public option, universal healthcare or deregulation all would have been better options.
It'd be much nicer to be able pay a doctor to make house calls as needed and waive your right to a malpractice lawsuit than to pay to support this insurance/legal/government system we have now.
Is there any alternative though? We're going to pay those costs one way or another: either the government pays for all the unprofitable patients' healthcare (the wet dream of health insurers), or we tell those people to go fuck themselves.
Those patients have no coverage so get Emergency treatment for acute symptoms of their issues that rarely fix the underlying problem, and beyond that we also tell them to go fuck themselves.
There are all sorts of things that should have (and perhaps even did) impact prices after the ACA. Not just coverage requirements (which, again: most employer-provided health plans --- which is what we're talking about here --- already complied with), but, more importantly: unprecedented instability in the insurance markets during the almost decade-long concerted effort by the GOP to hamstring and ultimately repeal the bill. And yet, the numbers are right there: health care costs are growing, but they are not growing more than they were prior to the ACA.
Sure, costs went up less after ACA.
However, the ACA directly added costs to insurance that weren’t there previously.
What were those?
Can you help me understand the argument you were trying to make above? I continue not to grok the point you were trying to make.
That being said, I'm not disagreeing that costs went up after the ACA more than they would have, but, IMO that was just insurers/providers raising prices because they could.
The system? No. Corporate welfare is great for "the system." But the consumers? Absolutely harmed!
> Again: the cost increases you're talking about were a fact of life before the ACA.
I've been working for over a decade now. 100% increases, year-over-year have never been even close to a thing with employer plans I've held. Not even close. Typically something in the realm of $20 per year at worst for a quality plan.
Here is another fun anecdote. I recently lost a job, and my firm was too small, with only 4 insured, to qualify for the COBRA. Total premium for the plan was roughly $150, roughly $75 per party as my employer paid 50%. Comparable coverage through the same insurer through the marketplace would have cost me nearly 4x as much.
The reality is the ACA allows insurance firms to sell obscenely over-priced plans to consumers. A sane system would have seen price controls in conjunction with the requirement for insurance. Instead I am forced to pay an insurer, pay the government, or prison. I would happily pay taxes for a fully nationalized system, but the ACA is obscene.
As far as I am aware, the ACA actually introduced limits on how much mark-up health insurance can have, where 80% of the cost must go to actual medical expenses, and administration, marketing, etc must be no more than 20% total. So how is the ACA the cause of insurance mark-up?
I think the actual root of the problem is not mark-up but that health care in the US is quite expensive (and always increasing). The ACA in some cases shifts who pays for it (young healthy people pay more), but it doesn't appear to change much the overall cost. It sucks temporarily for those younger people, but considering they will most likely become older, less-healthy people over time it doesn't seem that unfair overall.
> A sane system would have seen price controls in conjunction with the requirement for insurance.
If you are paying 4x more though, it sounds like the marketplace may be breaking down in your location with a "death spiral", where the price goes up, all the healthier people leave, causing the remaining insurance pool to be even sicker and the price going up even more. The whole purpose of the mandate was to prevent this, but it looks like it's been repealed. Price controls in that situation is hard since the pool is actually expensive to insure, I don't think the government can force the companies to sell at a loss. To reverse it maybe they could re-instate the mandate, or change it to a tax, or add a public option. Or, of course, give up on insuring pre-existing conditions.
> I would happily pay taxes for a fully nationalized system
Keep in mind, there are other countries like Germany and France that have private insurance markets and much cheaper care. I think it is fully possible for the US to implement a nationalized system that does not achieve the cost-effectiveness that we want. The VA system might be an example of how that might go.
One of the issues (and I like the ACA generally), is that that limit removes an incentive for the insurance companies to control costs and the 20% markup becomes a floor, not a ceiling. If they get 20% of revenue as non-medical costs, and they want to increase their profit, the best way to do that is to allow medical costs to increase. Then their 20% is larger because the pie of costs is larger.
One thing I wonder though, is that even without the 20% rule, if the company can get away with raising rates by 5%, wouldn't it make sense for them to do so? If they started with a 20% margin that would increase their profits by a whole 25%, instead of a measly 5% with the cap, so you'd think the incentives would be even stronger. It seems like adequate competition is the most important thing in a for-profit insurance model rather than having a 20% margin rule or not.
I don't think ACA plans are much more expensive that what we are _really_ paying for employer insurance. I recently became unemployed and when I priced it out, an ACA plan that offered benefits similar to what I would get with a COBRA plan were pretty much the same price - both ridiculously expensive, so I went with a cheaper silver HMO ACA plan. And my old employer charged a 4% "fee" on COBRA premiums as well - I guess the benefits companies want some of the action.
The only connection you’re making here is that your own costs went up after the ACA. It’s a post hoc fallacy.
The connection is that the ACA rates, and rate-increases are out-of-touch with the employer-offered system, even when those firms are tiny and not nearing some kind of "scale" cost-savings.
I have been hollering about this issue for years, and I've yet to have someone say "Ya know, I actually experienced something radically different." So where is all this evidence you claim but can't be bothered to provide?
There also isn't one "employer offered" system. In addition to the aformentioned small-group marketplace, there are also large group plans that cover big companies, and very big companies often self-insure, using health insurance companies solely to administer benefits but financing the care themselves. Can you be specific about which of these kinds of health care financing have been impacted by the ACA, and how?