>The point was that was state level...so other states could follow if they wanted.
When it comes to cost-sharing schemes the bigger the pool the better -- costs are more predictable the more people are in the pool.
I agree with the general idea that laboratory democracy is a good idea but health care costs, 'insurance' etc. are well understood and best handled at the largest level possible.
Hillary acknowledged problems with the ACA but believed that it needed to be patched, not re-written from scratch.
I agree. A few patches that would have a big impact:
A national public option to force competition (along with cross-state selling of insurance -- but not one without the other or at least that cross-state selling of insurance must be done across all states if offered that way) would go a long way to pushing competition and reducing perverse incentives that the ACA created with the 'profits based on percentage spent on care' scheme.
Redefining full-time employees as full-time equivalents for defining thresholds within the law. This was a flat-out mistake that pushed some employers to do some very silly things.
Create incentives for patients to shop around for the best cost of care.
Require some level of transparency in pricing even if it is only common treatments and tests.
The mandate would have to stay. The choice is, have a mandate and force people to buy insurance they need or don't have a mandate and force people who buy insurance to pay for the health risk of those who mistakenly believe they shouldn't have to pay for their own.
I tend to agree with you on all of those point, for a cost sharing scheme.
When a lot of people don't want the policy at all it becomes a cost forcing scheme though...and that's the crux of the problem.
If this was California legislation and it had problems, local politicians in California would be campaigning to make the changes right now. The question of how long we're going to be stuck with the current issues is where the federal flaw lies. It removes the ability of people to adapt and react to problems. The larger pool is a negative when the pool size expands the scope of issues.
Unless we are going to, as a society, agree that people who don't pay don't get treated for disease, then it is a cost-forcing scheme whichever path is chosen.
Before the ACA those that paid for insurance were forced to shoulder the cost of those that didn't. Now, those who think they don't want to pay for health insurance are forced to pay one way or another (though I think the penalty is too small).
I find it hard to feel bad for people that don't want to pay for their own health risk or who think they don't have any.
I lean heavily towards the libertarian side of things, but it didn't take that long for me to come to the conclusion that unless "we" (as a society) were going to let people die in the streets from curable diseases, we are all going to pay for everyone's health insurance, in some way/shape/form anyway.
I still believe a more open market would be a "better" solution, with a tight safety net to maintain standards across economic levels, but as that is unlikely, fixing the glaring issues with the ACA seems like a good starting point.
There is no reason we can't pursue both simultaneously. Nothing in the ACA prevents posting of price lists or incentivizing patients with cash payouts for finding cheaper than average care.
That is what has driven me crazy about politics -- it is more about making noise about the other side than actually doing something that might push things forward. Republicans could have pushed open market reforms the moment ACA was passed. If they did it on a state by state level they could even point to data of success vs pure ACA states to bolster their agenda.
Trump seems to think it will lead to the ACA falling apart. He might be right but only as part of the entire current insurance system falling apart around it. I really don't know what the intention was, there. As simple as fulfilling a campaign promise no matter the cost?
The issue is that based on the reasoning that people who were paying for insurance before were already bearing the costs. If that’s the case then it doesn’t make much sense for those same people to see dramatic cost increases.
When it comes to cost-sharing schemes the bigger the pool the better -- costs are more predictable the more people are in the pool.
I agree with the general idea that laboratory democracy is a good idea but health care costs, 'insurance' etc. are well understood and best handled at the largest level possible.
Hillary acknowledged problems with the ACA but believed that it needed to be patched, not re-written from scratch.
I agree. A few patches that would have a big impact:
A national public option to force competition (along with cross-state selling of insurance -- but not one without the other or at least that cross-state selling of insurance must be done across all states if offered that way) would go a long way to pushing competition and reducing perverse incentives that the ACA created with the 'profits based on percentage spent on care' scheme.
Redefining full-time employees as full-time equivalents for defining thresholds within the law. This was a flat-out mistake that pushed some employers to do some very silly things.
Create incentives for patients to shop around for the best cost of care.
Require some level of transparency in pricing even if it is only common treatments and tests.
The mandate would have to stay. The choice is, have a mandate and force people to buy insurance they need or don't have a mandate and force people who buy insurance to pay for the health risk of those who mistakenly believe they shouldn't have to pay for their own.