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Comment by mecameron | Hacker News Reader

Personal experience with nearly all health care insurance plans since the 90's: Each year the premiums go up, the out of pocket costs increase, and benefits decrease (beyond more than general inflation).

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I understand premiums going up annually. I don't understand 30-50% increases year on year.

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services.

And, to be totally frank, having had a pre-existing condition that kept me from buying any insurance (literally no one would sell to me pre-ACA), the law's been a net positive for me.

I feel bad for people in other states, in Oregon it was been a pretty sweet deal for me.

Yeah, it's pretty crappy in NC. First year of ACA we only had one company even offering any insurance in my county. And yeah, it's county-based for some reason - if I lived 2 miles in another direction I'd have had multiple options about 10-15% cheaper than what I had available.

Second year we had another option in our county which was about 15% higher than BCBS (which had gone up about 25% from the year before).

Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing?

We are > 100% from where we were wrt premiums from 2012. I expect some increase every year. I don't expect > 100%.

Colleague of mine is now facing > $1800/month health insurance pricing. He's... early 50s, married, 3 kids. This is with a $10k deductible. Another colleague with just one spouse and a child was facing going from $1300->$1650 this year, again with a fairly hefty deductible.

Given that this is effectively only something you'll get any benefit from if you're in a horrific accident of have a massive illness, this is now just really expensive catastrophic insurance.

I might feel slightly better about some of this if I actually knew anyone personally (beyond Frondo now!) who's benefitted. In my social circles, this has not even been close to a win for anyone. Either insurance has gone way up for people who can afford it, or it's still too expensive for some of my friends who are still unable to afford it (because they don't make enough money to qualify for the 'subsidized' pricing).

Bring on single payer...

We started on a $1500 indv / $3000 fam deductible PPO in 2014 for about $800/mo for two people. In 2015 the premiums went down maybe 0.5%. In 2016 the premiums have gone up 6% and the out of pocket max went up $500 per person to $4k.

ACA has absolutely been a net positive in my life. I had cancer in 2012 and so it would have been literally impossible for me to get health insurance outside of a group plan. With ACA I've been able to go independent, start my own business, choose my own clients, and fully control my destiny.

The ability to get insurance for an affordable price (the parameters of which I realize people differ on) with pre-existing conditions outside of group plans has been one of the big wins of ACA. It's at least reasonable to argue that particular problem could have been addressed outside of the massive and controversial implementation that was ACA as a whole.

I agree. The Federal subsidies should actually be limited to subsidizing pre existing condition coverage. I am willing to allow tax dollars to cover the difference of pre-existing condition coverage since it would be a net gain for everyone. The problem is that the subsidies are available for everyone, regardless of prior insurability, thus, just like student loans have accelerated college cost inflation, subsidies for almost everyone in the middle classes have resulted in price increases.

Essentially, pre-existing condition insurability is where the government could have make a huge impact with minimal disruption to the overall system. Much like there are government mortgage guarantees available for higher risk borrowers, the same kind of system could have helped the pre-existing conditions people get coverage while not throwing the baby out with the bath water.

The alleged goals of the ACA were to get everyone insured. However it shouldn't have taken thousands of pages to accomplish that. A good portion of ACA has nothing to do with insurance at all.

I wish there was some scope restriction on bills. For example the latest highway bill contained passport revocation provisions for those with delinquent taxes. This forces politicians to reluctantly vote for something they don't like because the overall bill is important. Poison pill amendments are often not poisonous enough so we get stuck with a bunch of really bad laws.

> The alleged goals of the ACA were to get everyone insured. However it shouldn't have taken thousands of pages to accomplish that. A good portion of ACA has nothing to do with insurance at all.

My own view is "getting insured" shouldn't really have been the goal, at least not with the current 'insurance' system in place. The goal should be making sure people have access to care/service, not access to purchase insurance. I have insurance, I'd be hard pressed to use it outside of a catastrophic event, because I have such a high deductible. Headaches with blurred vision... I may eventually go, but... I don't really want to be on the hook for $10k+ in bills just to find out "oh, it's nothing, get some rest".

Expanding medicaid would have ensured that more people would have had more direct access to care with minimal disruption to everything else.

> Yeah, it's pretty crappy in NC.

That's because your state is run by people who want desperately for the ACA to fail, and so they are intentionally making it as crappy as they can.

For comparison, my state's ACA plan is the same as Medicaid (several choices of insurance providers and I believe no cost for prescriptions).

The more surprising part was our Republican Governor was the one that advocated for it and pushed it through the party line (with a lot of grumbling). His argument was it would save the state quite a bit of money and so far I believe it has.

> Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing?

Well, the increased Medicaid funding is temporary, but comes with permanently higher Medicaid spending. So a state might reasonably not want to accept that offer.

Doesn't the federal government continue to cover 90% of the costs beyond 2020? That's still a pretty huge increase in funding.

To clarify, yes. After 2020, the federal government continues to cover 90% of the cost (compared with 60% normally) of the expansion indefinitely. So, for a state government, it is likely the cheapest way to ensure a large number of low income people are insured.

60% is not the normal federal share; the normal federal share varies by State, depends on state economic performance relative to other states, and is a minimum of 50% for certain populations, 65% for other populations.

What you said doesn't contradict the 60%. 60% is the normal federal share. I had a job that specifically involved forecasting state budgets (which obviously involved looking at historical trends) and forecasting the ACA's impact.

To clarify, these variations have historically averaged around 60%, and likely will continue to (sans ACA expansion): http://kff.org/medicaid/state-indicator/federalstate-share-o...

There's a difference between 60% being the normal federal share, and a variable amount that, averaged across all states, averages to about 60%, being the normal federal share, particularly when addressing particular states policies, since the share for any particular state tends to be pretty consistent over time (e.g., the California regular FMAP has been the minimum, 50%, because of the states better-than-average economic health for long enough that I frequently have to remind who work on systems where it matters that that's not a fixed amount) and maybe be significantly different than the average.

The increased Medicaid funding is permanent, though the 100% federal funding share for the expansion population drops in stages down to its permanent level, which is "only" 90%.

My premiums have gotten lower (in one case they were completely covered by my employer). My father is going through some very expensive medical care right now for cheap and my mother has insurance for the first time in more than a decade. What has gone up is my providers increasing their charges with the final negotiated price being something like 50% higher than before.

Let's be fair here. The ACA said that the feds would match the expanded medicaid enrollment for a few years, but after that the states would need to continue to sustain the larger enrollment on their own. Medicaid is a significant chunk of state budgets, and doing that meant raising taxes, or lowering expenses in other areas, or taking on debt.

It's not as simple as "screw obama, and screw poor people we ain't doing it." In the post-crash years, while money was scarce, there was some real concern over where the money would come from, how much it would need to cost, and how states would cope.

If your state can't sustain something with the federal government funding 90% of your expanded costs, then maybe you need to rethink the state you're in. It's no doubt, most likely in the "south" in some form, so I'm not surprised the government can't operate correctly.

I'm paying less out of pocket now than my share at my last job, with netter coverage... though this year I'm paying as much for a plan with $1k more for deductible... it's pretty sad... I keep it because I'm on a few medications that would be far more out of pocket.

Something needs to happen with USPTO, especially medicine at this point.

Something needs to happen with tort reform and the cost of FDA approvals. The FDA process is hugely expensive and inefficient. Contrast the FDA with Switzerland.

The patent system is essential for medicines. I know many people don't like that reality but who will invest in pharma companies if their investment could quickly be nullified due to the loss of intellectual property? Would you invest in a company when the competitive advantage that company is immediately rendered moot?

However, there are definitely places for reform, so I am not fully defending the USPTO system, I am simply suggesting that a strong patent system is a fundamental motivator of pharmaceutical innovation.

Pharmaceutical companies still make generic medications that are no longer covered by patents as well as over the counter medications. As for approval costs, the biggest cost for these companies is marketing, plain and simple. The actual people doing the research, I'm guessing are not solely guided by their pay or patents for that matter. I would presume that many people just want to make society better.

I am not suggesting that patents go away entirely, but their scope should definitely be reduced... extension patents in particular should not receive the same 20 years that original patents receive. The patent system has resulted in generations of gaming the system to the point where it no longer works.

I'm unconvinced that patents serve the public good in this day and age. I am convinced, however, that the vast majority of patents granted should not have been.

"Bring on single payer" - like the veteran's administration? Because that works so well?

Those #s are insane

The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions. EG: You couldn't make a national diabetes insurance plan for people with diabetes (and the economies of scale that go along with a pool of all people with diabetes) because it was effectively illegal.

If the ACA had merely fixed that, then your premiums would be going down more and you'd be getting better insurance.

You know what? My pre-existing condition was that I'd had my gallbladder removed in the early 2000s. That's it. Uninsurable for 10 years because of an operation which I recovered from fully in less than a week.

Telling me it's "regulations" that had every insurer reject me? Pull the other one, it's got bells on.

Citizen Frondo, you don't understand. If the market says you must not be insured it is right because the market is always right. Why, on this board you had people tell with a straight face that one should not bother to eradicate schistosomiasis and malaria in the African continent because if the continent was meant to be productive people would be spending money in the project right now.

If the OP is correct, then it is not the market that is enforcing the insurance scheme to reject cover for him based on pre-existing conditions, but rather the state that is making it illegal for schemes to be tailor-made for specific (pre-existing) conditions.

My preexisting condition was "history of headache". I was denied by every insurer that did business in our state in 2010 and 2011. I wish I was kidding. Had I failed to mention the headache thing and sought treatment, I would have been vulnerable to rescission.

My "pre-existing" condition was that I'd been to the doctor for heartburn in 2008 and been prescribed a 2 week course of medication.

Sorry - it wasn't quite the same as not being able to get insurance at all. Didn't mean I couldn't get insurance at all, but was 'rated' fairly higher than what was originally quoted.

>"The reason nobody could sell you insurance with your pre-existing condition before is that regulations prevented making plans for conditions"

I didn't know about this, but it changes quite a bit regarding pre-existing conditions. Could you please point me to a citation or something about this?

" Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better."

You are in the minority.

Every insurance company that provides Obamacare in Oregon is increasing rates for the average customer this year.

http://www.oregonlive.com/health/index.ssf/2015/07/more_than...

In fact, the State of Oregon has actually ordered some of the companies to increase their rates more than they'd originally planned.

http://www.cnbc.com/2015/06/22/oregon-dumps-cold-water-on-lo...

That seems really crazy, but then... Frondo just said the company he was with before went out of business. Why? Were they, in fact, not charging enough to cover their costs (supposedly the motivation behind Oregon raising prices)?

I feel bad for people in other states, in Oregon it was been a pretty sweet deal for me.

I moved back to Oregon from California several years ago. I was astonished at how much more expensive insurance was in OR than in CA.

I've been told that Oregon has had a lot of protectionism for local health insurers, so they didn't have to compete much. So perhaps you're just seeing Oregon coming into line with other states...

(By the way, I had a pinched nerve in my neck when I moved. No insurer would take me, and one told me that they wouldn't insure me until nine years had passed without any symptoms)

Unfortunately, your situation must be specific to Oregon. I'm in Washington, and the closest plan we could get to what we had pre-Obamacare went from a $2500 deductible to $6300 with a premium increase of around 40-50%.

In my opinion, the problem was never the unavailability of insurance. The problem was (and still is) the out-of-control pricing of medical care -- $5000+ for non-sterile gloves [1] is a bit extreme.

[1]: http://www.rd.com/health/wellness/wildly-overinflated-hospit...

I agree with you. I wish more people would realize their quibbling over a treatment for a symptom when they're hashing out a regulated private insurance marketplace v. single-payer. Our existing insurance system allows a lot of perversions of the marketplace and contributes to the root cause, but having the government sign a blank check isn't the answer either. We need to return ordinary market dynamics to health care if we want something that's sustainable over the long term.

The expensive gloves problem is due to cross subsidization and cost recovery. A good portion of the problem is due to under-market Medicare reimbursement rates; another part of the problem is that certain demographics that aren't eligible for Medicaid due to their lack of legal status incur expensive care (via the emergency rooms) that goes unreimbursed. This problem is especially accute in places like Texas.

I would suspect that more free primary care clinics could take some of the burden off of emergency rooms in terms of cost and those free clinics could even be funded by insurance companies from the money their saving from not having to pay for $5000 gloves anymore.

A cash-payment medical system would also solve some of these problems. With opaque pricing, hospitals get away with solving budget issues by overcharging. If you actually saw the menu of what things would cost and you were paying out of your pocket, nobody would ever tolerate $5000 gloves. Market forces would fix the cost overages very quickly. As it is now, very few people actually directly pay for their own care and thus are less motivated to care about price. "Insurance covers it," is all many people care about.

I think we need to talk way more about cost/pricing/fraud/transparency than the "insurance" red herring, which just became a problem because of cost in the healthcare sector.

It isn't ACA that has caused me problems, or at least the law itself.

The description given matched my experience with insurers before ACA. My problem with ACA is Healthcare.gov (still). It is possible to go through the entire application process, make one mistake or fail to provide the right detail, and end up disqualified from buying insurance through Healthcare.gov (in my case, I used a mail forwarding service address, because I travel full-time). There is no do-over, no online process for correcting the problem with the application. You have to go through a protest process that involves mailing physical letters somewhere. Fuck that. I'd go back to the nightmare that is pre-ACA private insurance, before I beg some bureaucrat, by mail, for the privilege of paying too much for insurance.

Healthcare.gov got a lot of flack in the beginning for costing too much, delivering too little, and being too flakey. All of those things are still true. It's also dehumanizing.

The traveling full time "problem" affects me as wel. When some company or another asks, "Where do you live?" My response is preceeded by an audible shrug.. I seems that many companies actually plan to come visit me and are put out when I explain that my physical location is really of no concern to them. For example, banking. If I give a Texas address and agree to Texas terms and conditions, why would it matter that I spend 11 months a year in Europe. My mail arrives, I do my transactions online.. So what's the problem? Twentieth century thinking, that's what.

Those are most likely regulations enforced on to the banks. By the time it gets to the low-level employee that checks/asks/confirms your address, it's probably morphed a bit, and each employee has their own interpretation of what is "okay" when it comes to addresses.

The federal exchanges (for which healthcare.gov is the portal) were never intended to be a good choice (or even to have to exist at all), they were in the law as a minimal fallback to be applied for states that failed to implement their own exchangees.

Yes, my "home" state is Texas, which has been extraordinarily regressive on ACA. It might be time for me to consider making another state "home".

Who's your carrier currently? I'm in Oregon as well, and I'm not impressed with the offerings here, at all.

I believe 18-20% was the norm for the past decade or two. Nationwide, I think the growth has supposedly slowed very slightly.

That doesn't make it any easier if you're one of the people who are getting screwed, though.

I've been buying insurance for a more than a decade, in multiple states. (direct, not via employers). I can't say I've seen annual rate increases of 20% year in year out for 2 decades. That's simply not sustainable.

By way of example, my $100/month policy would be $3800/month after 2 decades of 20% year on year growth.

I believe 8% annual inflation has been the normal rate for many years -- slightly decreased following ACA enactment, but rates then increased by a few points due to less-healthy enrollees, so it's a bit of a wash (not counting all the people who now have health insurance, to be sure). Premiums also only cover part of the cost increase; higher deductibles and reduced coverage are also used to defray costs, and aren't as obvious to the end consumers. Finally, plans that don't conform to ACA minimum coverage requirements have been killed off, so some individuals are seeing their rates increase commensurate with their improvement in coverage.

It's was pretty easy to predict: allowing enrollment after a diagnosis was politically popular but a terrible economic disincentive to not buy insurance (because at that point, it isn't insurance -- it's a subscription plan for your treatments).

The young and healthy needed to enroll for the economics to work, but the individual mandate was delayed for years -- because coercion isn't popular politically, and there was a reelection to win in 2012. Without the coercion, why would a 20-something buy insurance?

So begins the death spiral. The only thing that can save it is very high penalties for failing to get insurance on the individual marketplace. This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.

It's not only that you have to pay up so that others may wait until they're sick -- you have to buy a plan that covers things you don't need. I have to pay for all sorts of treatments I'll never use -- addiction counseling, prenatal care (I'm a man), etc. -- because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).

I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.

But, politically, that's dead on arrival. Democrats just voted to abolish the cadillac tax. Everyone knows the ACA is an albatross on the Democrats' neck. The sorts of anecdotes in this thread are all over the place. "We just didn't go far enough, try single payer" is not going to win the day anytime soon.

If a Republican wins the presidency, we'll see a full repeal of the entire thing (Dems will not filibuster if they know what's good for them). If a Democrat wins, we'll see gradual repeal, marketed as tweaks and improvements.

Personally, I'm fine with a strong subsidized public option for the truly indigent (oh wait, I just invented Medicare). After that, let the market bring costs down by removing regulations. It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed.

A good market would be one where you paid your doctor out of pocket for recurring, predictable costs and then bought insurance from a private company in order to guard against unforeseen catastrophes -- kind of like how your auto insurance policy doesn't pay for oil changes and car washes.

And what if someone is irresponsible and didn't qualify for Medicare but also didn't buy insurance? What happens if they get cancer? I hope they have family and friends to bail them out. It would be great for charities to lend a hand. I don't think the role of government is to take care of you, because it isn't the government taking care of you. It's the government coercing others to take care of you, against their will. It is not charitable to hold a doctor at gunpoint and force him to perform a surgery. So for everyone who believes that healthcare is a "right," I expect that you're freely giving away your excess time and money away? Or do you just expect others to?

I'm already paying someone else's medical bills -- I can calculate how much I give to Medicare each year, it's more than enough for someone else in this country to see a doctor for the entire year. I'm also paying way more than I should for my family's insurance plan because I'm indirectly subsidizing others. I wonder how many people are getting free healthcare on my dime, and what excuses they have for not being able to afford it on their own. I'm a little tired of being told how great it would be if I just paid a little more and others paid a little less.

> After that, let the market bring costs down by removing regulations.

This is hilarious, given that the US has the most expensive healthcare system in the world, outpacing far more regulated countries by vast amounts....

You might be right that you're hampered by bad regulation, but heavy regulation of the healthcare system have beaten the US consistently on cost for most of the developed world.

The United States' healthcare system undoubtedly is heavily regulated. It just so happens that it's simultaneously stupidly regulated: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730786/

> This would be politically disastrous -- "we know the plans are expensive, but it will be even more expensive to not get one!" isn't a great selling point.

IANAL but it's my understanding that the individual mandate only passed Constitutional muster because it was not punitive. If it were a penalty or crime instead of a tax, the legal interpretation might change. Then again, the Supreme Court had been all over the place lately.

It passed constitutional muster because the Supreme Court (specifically the Chief Justice) is unwilling to wade into this particular political morass. This was not the first decision which has been made by post-hoc rationalization because of magnitude, political significance, side effects, and judges' policy preferences, but it is one of the most notable.

"I don't think the role of government is to take care of you, because it isn't the government taking care of you. It's the government coercing others to take care of you, against their will."

The government does a lot of coercing people to do things against their will. That's why we have police, court systems, jails, and so on. Heck, we've had drafts! That's literally coercing young men to march headfirst into combat to protect the country!

And many people believe the draft is morally equivalent to slavery (which they do not support either).[1]

[1] http://gregmankiw.blogspot.ca/2006/11/rangel-and-friedman-on...

That's fine, I personally don't support the draft, but still. What about the legal system? Don't you see there is a problem with forcibly locking a portion of our population away behind bars? After all, that's what the government does, "for your own safety". Do you really feel safe in a country where the government can decide that murder is a "crime" for which you should be inhumanely LOCKED AWAY FOR LIFE?

P.S. Extreme sarcasm above...

The only justifiable coercion is against coercion. Someone injures you physically or financialy. Forcing someone to do something they don't want to including dieing or giving you their things is coercion. Coercion is always unjust and only fit as a reciprocation for coercion.

Cite?

*The Golden Rule. "Treat others as you would like to be treated"

So you're prepared to invalidate close to 100% of all employment contracts in the US?

Quite the contrary. Those are entered into willfully and not coercively.

But they are paid, largely, via taxes that I would believe many people would like to not pay. Taxation's gotta be a coercive thing... what's your take on that?

Does financial coercion exist? If wage slavery doesn't count, what does count as financial coercion?

I have recently revised my views in light of Michael Huemer's latest book, which I found convincing (, despite my initial reluctance to accept many of his findings).[1] It takes at least a book to explain his reasoning (which rightfully separates political legitimacy and political obligation from each other and independent moral obligations), and I won't bore you with poor paraphrasing here.
[1] http://www.palgrave.com/page/detail/the-problem-of-political...

You admit to sarcasm, but say the murder victim was an 3rd trimester fetus... now you have yourself a modern day political issue.

Was going to post something like this - you beat me to it.
"I don't think the role of government is to protect our country, because it isn't the government protecting our country. It's the government coercing others to protect our country, against their will."
Obviously, we have a volunteer force, but haven't always had that - conscription, as you brought up. It's fine to have a volunteer force, until we need more. Then force is brought in.

If you can't convince others to defend your country through rhetoric and compensation, perhaps the country isn't worth defending; your comment implicitly assumes every state is worth sacrificing young lives for.

> your comment implicitly assumes every state is worth sacrificing young lives for.
no, it assumes those in control of the state believe it is worth sacrificing young lives for.

Apologies if I misread your comment, but I read the following quote to imply that coercion was acceptable once the volunteer army was not enough:
>It's fine to have a volunteer force, until we need more. Then force is brought in.

I don't believe it is acceptable, but the people in power probably (often?) do believe that it's acceptable, generally because it's not their own lives at risk.

"... to secure these rights, Governments are instituted ..."

it's almost like our government is supposed to "establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare", right?

"It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed."
This isn't the best example to have chosen. All of these procedures are discretionary and nonessential. If I find the cost of an elective nose job too pricey, I can take my time and shop around. Or I can just go without a nose job altogether and be totally fine. The only thing that will suffer will be my vanity, and, well, it's suffered before. :)
On the other hand, let's imagine my kidney is catastrophically failing, and I need it removed or replaced. I'm probably not going to shop around at that point; I'm going to accept my doctor's recommendation that I be hustled into the nearest ER as soon as humanly possible, and I'll be stuck with the bill after the fact. I have neither the time, nor the expertise, nor the inclination to wait and comparison shop. For another thing, nobody is generally in a "market" for emergency kidney surgery. It's not something you anticipate. It's not something you expect to have done, much less seek out and shop around for. And there are no economic substitutes for the surgery. It doesn't lend itself to a market-based system in the same way that elective goods and services do.

Most medicine doesn’t happen on an emergency basis. E.g. if you’re diagnosed with cancer, or find out you should get a heart bypass, you have time to shop around for doctors.

And even in the case of emergency care, there's at least the potential that you could prepare in advance by familiarizing yourself with the market. But hospitals won't tell you what anything costs ahead of time, which is practically an invitation to gouge ("just leave your wallet and bank account passwords with the front desk...").
Even auto mechanics are required by law to give you a written estimate.

No you don't, because hospitals intentionally obfuscate their pricing, and in many cases it's impossible for them to even tell you what your final bill would be for a procedure.
This is the source of the problem. There is no 'market' to speak of. There needs to be laws requiring hospitals to provide prices up front and honor them after the fact.

> you have to buy a plan that covers things you don't need.
Well... isn't that sort of the point of insurance all together? There's always going to be someone in an insurance plan getting some treatment that I'll never need, no?

Can never need under any circumstances (prenatal care, for example).

No, it's not that the insurance money is going into a pool to pay for someone else getting that. It's that they are forcing you to buy coverage for something that you can't possibly use (e.g. child dental care for someone with no children).

>A good market would be one where you paid your doctor out of pocket for recurring, predictable costs and then bought insurance from a private company in order to guard against unforeseen catastrophes -- kind of like how your auto insurance policy doesn't pay for oil changes and car washes.
That works great if everyone is basically healthy. And it falls apart completely for people with ongoing medical conditions who either don't make a lot or are too sick to hold down a job.

If the government has billions of dollars in funds to blow up people, they have a few billion to heal people.

> It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be.
There is no need to believe or not believe. We are not talking about alternate realities, other modern, successful countries with better healthcare, longevity and quality of life have a single payer option.
> After that, let the market bring costs down by removing regulations.
Right. Point to any country where removing of regulations for healthcare has resulted in higher quality care.

There's no guarantee that a single-payer would cost any more to you out-of-pocket than your insurance premiums. In fact, being able to draw against bonds and general taxes suggests to me that it'd do better.
In fact, giving the sheer amount of bloat the entire billing apparatus of hospitals, the machinations of health insurers, the weird regulatory captures, and whatnot of the current system, I don't think it's unreasonable at all to at least give it it's day in court.
Your writeup to me basically reads as a "Fuck you got mine" libtertarian approach to healthcare, and one that frankly falls flat on its face if you acknowledge even the slightest personal responsibility to one's civilization or even to one's older, more enfeebled self.

I'd end up paying even more for everyone else who isn't paying.
You're neglecting the fact that unless you get hit by the proverbial bus, you will eventually have one or more very expensive medical conditions, just like those freeloaders you're being forced to pay for now.
The whole idea of selling "insurance" in a market where you know that everyone is eventually going to file expensive claims is just stupid. No other insurance market works that way, nor could it.

> "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer.
No, it's a consistent argument for those who think beyond themselves; it's good for society as a whole. One doesn't have to believe one personally benefits, that's now how liberals work.
> A good market would be one where you paid your doctor
A good market for healthcare is one where it isn't a market, but a social good provided to everyone, like other civilized countries do. The market is not the correct answer to every question of how to distribute goods and services.

No, but it is the only answer to how much those services cost, which is a necessary question to answer if you intend to apply accounting to resource allocation and consumption.

> but it is the only answer to how much those services cost
No it isn't; and that which can be asserted without evidence, can be refuted without it as well.

You assertion assumes ignorance as a starting point.
Be enlightened: http://wiki.mises.org/wiki/Price

The Austrian school, no thanks, that school of thought hasn't been mainstream since the 30's, for good reason; it's wrong. Here, you be enlightened and catch up to the modern world: https://en.wikipedia.org/wiki/Mainstream_economics

other "socialist" civilized countries, you know, like the ones that regularly innovate and push the boundaries of science and attract millions of people each year because of a higher standard of living and less taxes. oh, wait... The "market" is just a synonym for individuals co-operating together for their mutual benefit. The "public" option is one where a faceless bureaucracy with a monopoly on power steps in and dictates terms. Disclaimer: I have lived decades with a single payer system and left in part because of it.

>I have lived decades with a single payer system and left in part because of it.
No you didn't.

> like the ones that regularly innovate and push the boundaries of science and attract millions of people each year because of a higher standard of living and less taxes. oh, wait...
Propaganda Americans seem always believe, as if the rest of the world were a third world country. The Nordic countries top the world standard of living, America, not so much. Quality of life, the U.S. doesn't even break the top 10. The U.S. isn't a shining city on a hill, it's a waning rotten empire slowly sinking back into 3rd world status for its average citizen.
> The "market" is just a synonym for individuals co-operating together for their mutual benefit.
That's a nice theory, it's just not true in the real world.
> I have lived decades with a single payer system and left in part because of it.
And which country would that be?

>I have to pay for all sorts of treatments I'll never use -- addiction counseling, prenatal care (I'm a man), etc. --
Yeah, I know! Outrageous! Next thing you know they'll be asking me to pay to educate other peoples children!! Oh wait....
Having a society full of healthy babies (remember those babies are going to grow up to be adults someday) and people without substance dependency is beneficial to you.
Are you also upset that the people who live across town from you have roads that you never use?
The whole idea of "insurance" is to pool risk anyways. Do you also go on a rant like this every year you don't get into a car accident?
>because it was considered unfair that I should pay less for consuming less (why this argument doesn't transfer to auto insurance, where men pay higher rates, I don't know).
There are some countries (and Montana) where gender discrimination in auto insurance is illegal.

You're unfamiliar with how the American political system works. Presidents can't repeal laws, only Congress can do that.

> I know liberals are going to argue "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. Some people would be; I know I wouldn't be. I'd end up paying even more for everyone else who isn't paying.
US government currently pays more per capita than eg UK NHS, and you still get stuck with insurance, co-pay, and bills for your very expensive health care.

Because the ACA is the largest transfer of wealth from the youth to the aged that has ever been attempted. It also is because the fines for not buying into the system are too low that participation by healthy people isn't sufficient to pay for the sick.
The process is designed to make people so irritated with insurance companies that they demand the government take over as payer when it is the government that created the mess in the first place, approved the rates, and then set up the impossible system of not forcing everyone paying.
I am all for a system that pays for checkups and catastrophic but lets be honest, if the system is wholly free so much money will be lost to worry warts it won't be funny. there needs to be a deductible but not so high that people who need something done don't

Not like this.
Right before Affordable Care Act went into effect I checked my insurance quotes so I could later compare how much money I would save getting affordable health insurance (which is how Obamacare was sold - that it would put the insurance companies in check and make everything affordable).
It was a 300% increase.

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