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Comment by DennisP | Hacker News Reader

Anyone who wants to work freelance or do a startup, rather than work for an employer, and who has any sort of preexisting condition, is definitely helped a lot.

People here are complaining that their insurance got pricier. The reason is that insurers aren't allowed to exclude sick people anymore. If you ever get chronically sick, you'll appreciate this change.

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It actually makes health insurance worth a damn now.

Before if you had minor medical stuff insurance was there. But as soon as you got legitimately sick (e.g. cancer) they quite literally went back through every form you ever filled out looking for an error, typo, or omission in order to cut you.

Worse still they actually designed forms to increase the chance of error for exactly this reason. Did you ever wonder why you have to sign it three different times on different pages? That is why.

Plus if you got laid off previously you were in deep trouble since your new employer's insurance company would reject you and you'd struggle to work while sick regardless.

Honestly Obamacare improved things decently. Only short-sighted greedy people are unhappy. Next challenge: Unlink health insurance completely from employment.

Health insurance from your employer is bad for everyone. It reduces consumer choice (e.g. you have the "choice" to either go with the company your employer picked or nothing), and it makes SMBs much less competitive than large corporation.

Startups in particular struggle to offer employees health insurance even if they can afford to offer a competitive income (as they pay disproportionately more for health insurance than a much larger company).

At least an argument can be made for why the "public option" (nationalised health care) is a bad idea, I've heard no good arguments for why unliking employment from health care is. Except "I get really good healthcare right now and I am too lazy to shop around for it."

The only organisation that should be allowed to offer their own health insurance/care is the US military, and that is more for practical reason.

Well put. Unfortunately, too many people can't get past "the government is taking my money".

It is a bizarre consequence of our modern politics that so many have become so enchanted with this mantra, as if there is "correct" portion of each dollar that should go to the government, and whatever is currently being taxed is too much, regardless of what needs to be or should be paid for.

Except the US spends $8,362 per person per year. The UK spends $3,480 per person per year. http://www.theguardian.com/news/datablog/2012/jun/30/healthc...

What's your point? The US outspent all the other countries prior to the ACA as well.

My point is that the US is spending extra-ordinarily amounts of money on healthcare system which is not universal, nor free at the point of delivery. Obama did want to put in a national healthcare system, but the opposition was just too much, so ACA was the best compromise that his administration could get through congress.

There was so much disinformation put out about nationalised healthcare systems. My favourite was the people in the States where being told that Canadians and Britons where not allowed to choose their doctors.

Overtime American healthcare costs should come down as people who where previously excluded from the American Healthcare system get treatment and advice for non-acute conditions. Before ACA, they would have had to wait until the conditions where serious enough for Emergancy treatment.

You should watch the (very excellent) Frontline special on comparative national health insurance plans. It's an evenhanded take from a left-leaning source with serious investigative journalism chops.

Over the long term, the ACA produces a system that most closely resembles that of Switzerland. Switzerland's health insurance system was the least fraught of the options Frontline looked at.

It is not reasonable to suggest that the UK NHS and Health Canada are without problems. They have significant issues, particularly with regard to allocation of specialist care.

The US spends 17.9% of its GDP on Healthcare. The UK by contrast spends 9.6%. (Canada is 11.3%) I read another article that says the US has 2.2 administrative workers per office based physician, Canada is 1.1.

It just seems to me that the 'Private' system that many Americans insist is better than the 'Public' systems that the rest of the 1st world is simply not the case.

I think that if you either are fantastically rich, or work for a company like Microsoft, then the average person is better off with public healthcare system of a 1st world economy (or Cuba).

Hope I don't appear defensive with this, but I don't think I ever came close to suggesting that 'the UK NHS and Health Canada are without problems' and that for you to suggest the issues they have are more significant than the issues facing American healthcare is totally disingenuous. Simply put, all users of the health care system from unemployed worker right up to the Royal family have access, and use the same system.

I have significant (anecdotal) experience with the American, French, Canadian (BC), and British (England and Scotland) systems with family and friends with geriatric, orthopaedic, and oncology care. I can tell you definitively that you are better off anywhere but the USA. The care that was/is given in the Canada, the UK, and France was excellent. It seemed to us that only thing that mattered in the States was who was going to pay the bills.

http://www.theguardian.com/news/datablog/2012/jun/30/healthc... http://www.bbc.co.uk/news/uk-19317991

Perhaps worth noting, France is not a single-payer system. It has nonprofit private insurers, an individual mandate, and no exclusions for preexisting conditions. It adds good electronic medical records and a national price list for medical services.

Source: The Healing of America by T.R. Reid.

My central point, as a percentage of GDP, the French economy spends 11.9% on healthcare in aggregate. The French system is user pay, government refund, based on means. The US spends 17.9%. The better question is why does the American Healthcare industry occupy such a large fraction of the American economy? It is especially interesting 47% of that figure is private spending, and that 53% is government spend. Canada has nearly 30% private spend on its healthcare, France 22%, Britain 16%. Per capita, the States spends the 4th largest amount. In very broad terms it seems to me that Americans are getting bad value for money for their healthcare system.

http://www.theguardian.com/news/datablog/2012/jun/30/healthc...

  Only short-sighted greedy people are unhappy.

The polling numbers disagree with you:

http://kff.org/interactive/health-tracking-poll-exploring-th...

That neither agrees nor disagrees with what I said.

But if you want to make broad sweeping statements about political party affiliation and views on social good Vs. personal wealth/greed, then it more supports what I was saying than anything (see political party Vs. views on Obamacare graph).

OK, then the majority of independent voters are short-sighted, greedy people. Your polemics undermine your arguments.

>"Before if you had minor medical stuff insurance was there. But as soon as you got legitimately sick (e.g. cancer) they quite literally went back through every form you ever filled out looking for an error, typo, or omission in order to cut you."

This is pure truth in my experience [1].

Yes, all of it, but it's not just your forms - they'll scour phone calls too. Anything you've communicated can and will be used against you.

Problem is, it's the sort of thing that seems too unlikely or simply too far off until, out of blue, it hits you on the backside of a routine visit. More insidious is the way the scheme necessarily limits the number of people who survive to talk about it.

1: I spent years fighting this on behalf of a terminally-ill family member and I witnessed the lengths a company will go to in order to avoid making payouts first hand while working for an insurance company.

When you hit lifetime limits it's pretty harsh to... After 6 years, I'm finally under $10k owed to medical debt, and that's still quite a lot. I'd had to defer those collection companies that wouldn't negotiate, or wanted monthly payments that were disproportionately large, which are now all that is left. Though, my credit score now hovers around 600 as a result of the negative statements (all medical).

I think the biggest problem with Obamacare is the sheer number of exceptions for existing insurance plans... most of which still don't meet the minimum requirements for new plans. Also, I think that an NPO insurance organization is needed to provide a competitive baseline, which we also don't have.

I'm strongly against taxes for simply being alive... that said, there are definitely things that could/should have been done to make things more effective and less costly overall. Clearing import restrictions would go a long way... reducing the strength of derivative medical patents, and the terms of copyright on government funded research papers would as well.

So post-menopausal women are now required to buy a more expensive plan that includes maternity coverage because, "insurers aren't allowed to exclude sick people anymore." Sure...that makes sense.

The idea that a typical post-menopausal woman could easily obtain any kind of health insurance on the individual market prior to the ACA is laughable.

I didn't just make that up and this woman that I know really did have insurance before ACA (sans maternity coverage, for obvious reasons).

I have zero doubts that there are post-menopausal women who were able to obtain coverage before the ACA, just like I would not bet every dollar I had to my name if I found myself holding AA before the flop.

Or for that matter if you ever spontaneously change genders (statistically speaking), because getting health insurance prior to guaranteed issue was treacherous for women. We were routinely denied family coverage.

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