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129 points geox | 5 comments | | HN request time: 0.002s | 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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toomuchtodo ◴[] No.44604907[source]
Bipartisanship is dead. If you want to win, play to win.
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brookst ◴[] No.44604998[source]
Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
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toomuchtodo ◴[] No.44605081{3}[source]
I'm somewhat hopeful with Gavin Newsom's posture making an example, I wouldn't vote for him, but I like the aggressive PR position he's taken, his willingness to gerrymander just as the other side has been doing forever. That's what I mean by bipartisanship is dead. You can't negotiate with the other side, they do not want to negotiate, they want to win at all costs for ideology, so you can only do your best to disempower them. If you try to play fair with a counterparty who does not believe in acting in good faith or playing fair, you have default lost. You can't have a functional democracy when one side rejects democracy (massive efforts to disenfranchise voters, gerrymandering, etc) because they can't win democratically. There is no reason you can't have empathy while punching down at bullies, because if the tables were turned, the bullies would put their boot on your neck ("paradox of tolerance"). So, start punching down.

Edit:

In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves (considering how dependent red states are on the federal government [1] [2]); Oregon is up first [3]. You can increase state taxes to fund this, reducing tax dollars sent to the federal government, if properly engineered.

[1]. https://time.com/7222411/blue-states-are-bailing-out-red-sta...

[2] https://usafacts.org/articles/which-states-contribute-the-mo...

[3] https://www.hcfawa.org/oregon_s_path_to_universal_health_car...

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ceejayoz ◴[] No.44605519{4}[source]
> In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves…

The risk here will be sick people (and their high costs) moving. As with how Chicago's illegal gun problems mostly come from Indiana.

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mostlysimilar ◴[] No.44606351[source]
If blue states can build enough housing to welcome refugees from collapsing red states then great. Caring for people and building bigger concentrations of healthy people is a good thing, especially as the House is proportional to population.
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1. ceejayoz ◴[] No.44606375[source]
This would be far more likely to concentrate non-healthy people, and all their costs. The needy in red states will move for access to care; the red states will see a healthier and cheaper population as a result.
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2. toomuchtodo ◴[] No.44606709[source]
I am willing to bet $10k to a 501c3 charity of the winner’s choice this doesn’t happen and that the thesis is deficient. Let me know if you want to take the bet, we’ll use Longbets.org to officiate.
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3. ceejayoz ◴[] No.44607777[source]
Gonna gently suggest to you that someone who can go "I'll put $10k in escrow for a few decades over an internet comment" perhaps may struggle to understand the desperation of someone with a disabling chronic illness to get access to medical treatment. (And their lack of means to match such a bet, no matter their confidence in the position.)
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4. toomuchtodo ◴[] No.44608031{3}[source]
On the contrary, I financially support several people who are disabled and will never work again (to bridge them until they qualify for age tested benefits). I bought a piece of land in the Midwest, and am building tiny homes for them one by one. I previously did a short stint as a Guardian ad Litem in Florida for disadvantaged children who needed an independent advocate, and I act as a patient advocate today for folks who need healthcare and have a hard time accessing it. My deceased mother could not claim Social Security disability while genuinely disabled, and I was first hand involved in the process to see how the system is built to prevent entitled beneficiaries from claiming disability benefits up to her early death at 60.

I am resourced (out of luck), but also high empathy and intimately familiar with the struggles you mention. The bet isn't only because I can afford it, but because I am so familiar with the data I know I'm right. This is why I am for universal healthcare, see no other path forward, and I hope this better explains the mental model my arguments in this context are based upon.

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5. ceejayoz ◴[] No.44608286{4}[source]
> The bet isn't only because I can afford it, but because I am so familiar with the data I know I'm right.

I mean, same position here. I just don't have $10k to sit in escrow for years. I've similarly got plenty of first-hand experience; one on Medicare and one on Medicaid in the family due to disability, and even with those and a reasonably well paying job we'd absolutely consider moving for a program as described.

Data-wise, we've already got quite a bit demonstrating that California's better-than-average social services are more attractive to homeless folks, to the point where they have ~25% of the country's population of them.

I'm also for universal healthcare. I just don't think doing it unilaterally at the state-level is likely to work very well with freedom of movement between states, as with gun control.