Comment by cogman10 | Hacker News Reader

Comment by cogman10 | Hacker News Reader

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> Plus it is not literally putting money in people's hands which is often unpopular with some demographic groups

I'd be really opposed to this. It'd only be ok if we nationalized the industries where we set these rules and rates. Otherwise, this ends up being a simple handout to private industries.

For example, let's say we say x liters of water. Well who's deciding how much x liters cost? If it's a private company and the government is guaranteeing it, you can bet water (which is relatively cheap where I live) will end up being the most expensive resource imaginable. And that may actually be true depending on the location, but it'd also be true in non-desert areas with plenty of water.

We've effectively had that here with the ACA, where the government has decided that it will cover the first $800 or so dollars of your health insurance. What happened? Magically, the cost of health insurance increased by $800. Private industries aren't stupid, they'll always charge the maximum price the market will bear. And when we start talking about captured industries like data provider, power provider, or your water provider... well that's where we can trust private industry the least as they literally have the public over a barrel. Utility boards are an OK solution, but the better solution is to turn these into public institutes instead of private ones.

> We've effectively had that here with the ACA, where the government has decided that it will cover the first $800 or so dollars of your health insurance. What happened? Magically, the cost of health insurance increased by $800.

I don’t think that’s an accurate description of ACA [1], it didn’t lead to a dollar to dollar increase in premiums (share a citation if otherwise), and it’s a bit misleading to say it led to an increase in premiums because plans pre-ACA were effectively inaccessible to and lacking in benefits for impoverished people or people with pre-existing conditions.

[1] Here’s a brief description of ACA from Wikipedia:

> The act largely retained the existing structure of Medicare, Medicaid, and the employer market, but individual markets were radically overhauled.[1][11] Insurers were made to accept all applicants without charging based on pre-existing conditions or demographic status (except age). To combat the resultant adverse selection, the act mandated that individuals buy insurance (or pay a monetary penalty) and that insurers cover a list of "essential health benefits". Young people were allowed to stay on their parents' insurance plans until they were 26 years old.

There will never be a cited reason for increases, but here's 2023 where basically all insurers filled for a 10% increase in premiums. [1]

Since the 2022 covid bill which significantly increased the subsidization of premiums, health insurers have found various reasons to increase their premiums by inflation beating numbers.

That's obviously a "the market will bear it" situation.

The ACA was a big bill that did a lot. I'm not talking about all of it, but rather the premium subsidization along with the covid premium increase which both expired in 2026.

Look, the premiums expiring was bad. IDK if that was clear from my earlier comment. But there's a fundamentally unaddressed issue with insurers in general where they charge not based on competition or the cost of service, but based on what consumers can bear. Profit incentives for healthcare in the US are completely misaligned with providing good general healthcare. The ACA premiums are a bandaid over an artery laceration. Better than nothing, but that thing is going to very quickly start bleeding through. You can keep slapping on band-aides, but ultimately you'll be looking at more damage if you don't just address the issue.

[1] https://www.healthsystemtracker.org/brief/an-early-look-at-w...

Aren't utilities, by definition, state owned? Or is that also backwards in america?

Utilities in America refers to the service relative to ideas of basic needs for survival in the US so they are often public infrastructure with private operators but in the case of some things like the internet, it’s purely privatized.

It depends. Water is usually provided by the city here, but most electricity and natural gas is corporate-delivered.

We don't even own all of our roads here. Sometimes we sell city streets to parking companies.

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