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Comment by jdlshore | Hacker News Reader

That doesn’t pass the sniff test. I was self-employed and self-insured when the ACA took effect and my premiums immediately dropped when I purchased through the Marketplace (and it wasn’t subsidized).

It sounds like you either had junk insurance or you’re exaggerating things to score points.

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I find it VERY likely they had a junk policy. This is one of the most important things the ACA did, it defined what could be considered health insurance. Before the ACA, a company could sell you a policy that essentially covered nothing. Usually those junk policies had cleverly worded agreements that hid the fact that nothing was covered (pre-existing conditions, restrictive networks, carve-outs for expensive treatments, etc).

Since the majority of people don't run into those issues, they are blissfully unaware that if/when they have a major medical event they are under-insured.

When the ACA plans first came online in South Carolina, I switched over immediately. I was paying something like $300 per month as a young healthy single male with my small company plan. I got a Marketplace plan for about $120 per month. The next year my insurer went out of business but I found another insurer in the 200s, barely cheaper. The following year this insurer also went under. I was now left with Blue Cross as my only real option charging I believe $350 per month and this continued to rise year on year, very painful for me when I was launching a startup with a minimal salary draw. Maybe your state is different but for me it killed numerous companies and left me with expensive, low quality options.

Yes, health insurance costs rise every year. Partly due to increasing costs, but also due to the age of the insured.

The question isn’t whether the ACA raised costs—those were always going to go up. The question is whether a the ACA made them go up less than not having it. For me, the before and after trend was remarkable. And I had higher quality insurance without lifetime maximums or arbitrary exclusions.

Republicans did their level best to neuter the bill and prevent Democrats from having a “win,” and for the most part, I’d say they succeeded. The lack of a public option and the removal of mandatory coverage were both important parts of making it work well. But in the first 5 years or so, it was definitely an improvement. I think it could be again… if Republicans cared more about serving the country than pandering to their base.

> those were always going to go up

No. That wasn't the promise. Obama said that his plan was going to cut a family's bills by $2500.

Now you may say that inflation has to creep in and I think that's fair. If oil rises in price, that affects everything. But the premise was always that the magic of the ACA would lower premiums.

I recall the "magic" of the aca actually being focused on junk insurance so bad they look like scams, a marketplace to facilitate apples-to-apples competition, and most importantly, making it illegal to deny coverage to people because of genetic tests or public/stolen information like that (a great thing to see the 23&me breach coming).

My impression was it would be painful in a lot of ways but we need better competition and better protection in order to have the private insurance industry actually work for people instead of abuse them and health insurance is too important (and complicated, and too much history of dishonesty) for laissez faire.

Over the course of my life I have seen every profession but one go through boom and bust cycles.

I've seen attorneys, professors traders, plumbers, programmers, accounting, all go through demand cycles.

But never MDs

It is my dream that before I die I see a bust cycle on MDs where the growth of supply exceeds the demand.

Uber or Airbnb for medical care is so needed, why not break some laws to reveal how protectionist the whole industry is?

I'd gladly book a "Parody Doctor" or whatever it takes if it cost 2/5ths the price.

Passes the test of my freelancer friends. They said at lunch that the long term change has been dramatic. What cost $300/m before the ACA turned to $3000/m today. These are all through the local Blue Cross. We talked about the junk policy idea. Certainly the post-ACA policies have some improvements like no pre-existing conditions, but it's pretty much a tangerine-to-oranges comparison.

Maybe yours dropped immediately, but I'm sure it's up quite a bit since then. You may say that's just inflation and that's part of it, but I think the deeper point is that the ACA is not containing the inflation. And that was one of the promises.

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