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129 points geox | 4 comments | | HN request time: 0s | source
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brandonb ◴[] No.44604783[source]
The ACA was originally designed as a "three-legged stool" of nondiscrimination (insurance companies can't charge higher rates to sick people), the individual mandate, and subsidies.

If you remove one of legs of the stool, the market becomes unstable and you see price spirals like this.

Jonathan Gruber (MIT econ professor, and one of the designers of the Affordable Care Act) gave a fairly detailed talk about how and why they designed the ACA the way they did, learning from a similar law in Massachusetts: https://youtu.be/2fTHqARiV_Q?si=SRC6Np-rjgUgAe4Z&t=679

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mystraline ◴[] No.44604881[source]
Yep, the ACA was originally RomneyCare.

Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls capitalist plan.

Heritage foundation made this plan after Hillary Clinton pushed universal healthcare in 1994, as first lady. Howls of 'death panels' were heard all over republican talking points and radio shows.

(The 'death panels' aka rationing was seen as bad for government to do. However, we see a new type of rationing, based upon how much patients cost, and then denying care. That lead to the UHC execution, then approving more procedures, then getting sued by shareholders for that. Personally, government death panels are preferred to capitalist death panels.)

Put simply: Obama passed republican legislation put forth by a republican governor and a republican thinktank, and was deemed a socialist. And now, the program is basically destroyed.

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potato3732842 ◴[] No.44604935[source]
People need to take a step back and take the red/blue team fanboy emotion out of it.

It wasn't "destroyed" because it was "deemed socialist". It was destroyed because it used tricks of law to get something that didn't have broad enough support at the time done and those regulatory tricks were not durable. Same exact story as Roe v Wade but in a much more compressed timeline.

Unfortunately, the whole debacle has likely hardened the resolve of everyone who is against it even though a functional Romneycare system would likely be satisfactory to them (and needless to say an improvement over the status quo).

Turns out "the perfect is the enemy of the good, ship it" isn't how you run a society. This is a common theme. Stuff that's 50-50 either gets gutted or repealed with time. Something needs to be truly popular, like will lose you votes if you undo it, in order to stick around. For example no amount of pothead deadbeats or drunken wife beating is bringing weed or alcohol prohibition back at the state level.

We're 15yr on from the ACA and with very few exceptions things are worse. The nation likely would have been better served by letting the states that were inclined to run such systems continue doing so without federal meddling.

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1. ceejayoz ◴[] No.44604966[source]
The regulatory tricks were upheld by SCOTUS.

Republicans just zeroed out the penalty in the individual mandate after that decision. They knew what that would do; that's why they did it.

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2. potato3732842 ◴[] No.44605141[source]
And where did they get the political capital to do that?

They got it from the approximately half of society that they could pander to by saying "look, we did that, vote for me and I'll take it even farther" at the next cycle.

The ACA is going to go down in history as something that caused some yet unknown number of decades of suffering because it was just barely too much just barely too soon. If they'd have kept it in their pants another decade or maybe even less, or legislated a more incremental solution at the time we'd probably be 5yr into something workable by now.

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3. mystraline ◴[] No.44605216[source]
And some of us remember that asshole, Lieberman, was the one who blocked the Public Insurance option (aka universal insurance fund, a type of single payer). And he also blocked having medicare/medicaid from again negotiating for drug costs.

I keep saying, cause its true: this is a republican plan, pushed by republican governor, and by a republican thinktank, branded as socialist because a black democrat had the audacity to push it.

4. ◴[] No.44605394[source]