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Comment by rndmize | Hacker News Reader

Not the GP, but these are social issues largely, and while I care about them, I consider them less important than economic issues (for a multitude of reasons). And on economic/business issues, the two parties seems to have minimal differences.

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Health care is squarely an economic/business issue that affects nearly everybody, and there are clear, meaningful differences between the two parties here.

AHCA, Obamacare is definitely better than before, it guarantees open access to many who didn't have it before. A good thing.

But it didn't go far enough. It played in to the corporate healthcare system demands by not offering a competitive public option. The so called Blue Dog democrats blocked that, which is such a shame.

Far better than anything the Republicans have put on the table. The problem is that we basically have one sane party which is backed by corporate interests, and another party backed by the same or similar corporate interests which plays off fear for support.

I believe the only fix to this is to weaken party entrenchment, and have ranked choice voting in place; but who in these two parties would actually support that?

[Edit: typo]

I completely agree. I was just pointing out to the poster I was replying to that with regards to one of the most important economic issues the US currently faces, there are meaningful differences between the two parties, despite the fact that they are both backed by mostly the same corporate interests. I'm tired of the "both parties are the same" trope. Current events clearly contradict that.

Isn't it obvious that it's a matter of perspective? Ask two non-programmers the difference between Python and Haskell, and they'll say, "They look the same to me." Ask two programmers the difference between Python and Haskell, and it's a fair bet that they'd be able to list off a laundry list of differences. Both perspectives are actually right, and neither one is a "trope" as you put it.

What you think of as meaningful differences someone else might think of as nominal differences.

The differences between Python and Haskell only affect programmers and people who employ programmers. The difference between the two parties approach to health care affects everybody in the US. It's not simply a matter of perspective.

My point is that you see a large impact between the parties while others might see a low impact between the parties. That is a difference of perspective.

People who can't distinguish between the meaningful impact of the differences between the two parties approach to health care are not paying attention or willfully ignorant. Bringing out the trope perpetuates this. It's a real problem.

I'm trying to explain a perspective that is clearly different from yours. You're free to reject it of course, but snubbing your nose at it doesn't seem productive. It certainly won't make it go away, no matter how much you declare it to be a trope.

> not paying attention or willfully ignorant

I love how you've left out a third choice, which is, "they just disagree with me and my own economic forecasts." You know you've really gone down an interesting road when the only way someone can disagree with you is if they're a boob (accidental or not).

I'm specifically not making a value judgment on the approaches of the two parties. Health care is a complicated topic, and there are many approaches of with pros and cons to each. All I'm saying is that the parties have fairly different approaches to the issue, which are meaningful, due to some fundamental principles on which they differ.

You've been saying how there's a perspective where they do not meaningfully differ, but you have not actually articulated how that perspective is valid. My position is that this perspective is not valid, and recent events with the AHCA have made this very clear.

The next time you want to have a conversation with someone that disagrees with you, you might want to consider not calling them an idiot. Namely, you haven't articulated anything either. No value judgments? Please. The subtext of your comments is oozing with value judgments.

Obamacare increased the cost of my families healthcare from $400 a month to $1800 a month, and now my family doesn't have long term healthcare insurance.

So please keep telling me how it's better.

So what else changed. Did you get more coverage for things? What happened to your premium? How much did you use your $400 insurance (i.e. did it actually provide coverage.)

Price is an important aspect to health-care but devoid of any other information it doesn't mean much.

The framing of your question implies that for every dollar you spend there is some return (risk-adjusted, to account for the possibility you did not need that care). Why should that be the case, if poor public policy allows health insurance providers from acting as monopolies?

Consider: http://quotes.morningstar.com/chart/fund/chart?t=VHCIX&regio...

I suspect that you already know the answer here: better !== better for everybody, and worse for you !== worse for everybody.

A lot of people even think that "more expensive for most" still qualifies as "better" as long as it means that people that previously could not get coverage at any cost are now able to, since none of us know when we might develop a "pre-existing condition" that pre-ACA would have made us uninsurable forever.

Whether a system is truly better or worse depends on how you account for all the different people that it helps or hurts. http://www.politifact.com/truth-o-meter/article/2017/jan/05/... has some examples that suggest that things are better for a whole lot of people under ACA, but I'm sure other groups and analyses will paint different pictures.

Premiums were rising before the ACA was enacted and continued to rise afterwards [1].

> So please keep telling me how it's better.

It expanded Medicaid and gave premium discounts to lower income brackets in states that accepted it.

[1] http://i.imgur.com/sKUm2u0.jpg

The posted graph(http://imgur.com/sKUm2u0) shows only 1999 onward. From the articles I've seen, the trend of increasing health care costs (2-3x rate of inflation) extends as far back as the mid-80's. The broader trend is largely independent of the ACA and remains a huge issue.

Speaking of the graph... what is that huge gap that opened between between "Workers Contribution to Premiums" and "Premiums" in 2010, right when the ACA was signed into law? Is that just... raw profit taking?

Another anecdata on the "worse for me" side...

My income has been pretty irregular over the past few years. All but two months I've made $0. In two months I made many tens of thousands of dollars. I got denied for free coverage because of the two months I earned money. I got denied for purchasing through the exchange because my projected income was $0/mo. /me is an edge case, I guess. So, having some time off, I left the country for 8 months and didn't purchase US insurance while I was on the other side of the globe. Another edge case found...since I wasn't outside of the country for 11 months in a calendar year, I had to pay the penalty for the entire year, despite being nowhere near US health services for the entirety of the time I didn't have health coverage. I now have health coverage that I'm purchasing directly from a health insurer. It's expensive and a plan I could have bought pre-Obamacare.

As a programmer, I see Obamacare as the equivalent of rushed code that only works for the primary success case and crashes whenever you throw any abnormal situation at it. Too bad they couldn't have hired Silicon Valley engineers to fix the legislation as well as they fixed the healthcare.gov website. I've found at least 3 bugs in it that need to be fixed.

Have you 'reported the bugs'?

It is not better at all. The deductibles increased tremendously, and it wound up turning normal insurance into expensive catastrophic insurance. Many poor people are worse off under it, because at least before it was possible to pay for insurance with a decent deductible as part time help. Now most of them just eat the tax penalty (or avoid it, there is a provision where it can be waived if you demonstrate it's literally too expensive to afford) and have no insurance at all.

The solution would be employer-matched health savings accounts for casual care, with mandatory from 18-up catastrophic insurance at low premiums.

> Now most of them just eat the tax penalty (or avoid it, there is a provision where it can be waived if you demonstrate it's literally too expensive to afford) and have no insurance at all.

Don't the increased numbers of insured people contradict this statement? Being poor still sucks, and having to make this choice, still sucks. But it also expanded Medicaid coverage to more people.

They should have offered Medicare as an choice in every market, or at least every market where there are fewer than three options on the exchange.

> mandatory from 18-up catastrophic insurance at low premiums.

Isn't that what the law does? The mandatory bit is enforced with the tax penalty.

I continually heard some years back that Obamacare was basically Romneycare which was basically the Republican plan from the Clinton years. Further, as we can see from the current state of things, the Republicans might say they hate Obamacare, but now that they have a chance to repeal it and put their own plan in place, they've failed continually. There's no politically-tenable position to move further rightward unless you are in favor of less people having care or people having worse care.

In short, the Democrats basically adopted the old Republican position on the only economic issue listed by the OP - exactly in line with my earlier point.

The Democrats adopted Romneycare with some tweaks as a compromise effort. They view it as a starting point, not the end goal. Any attempts to move beyond that starting point were obstructed by Republicans.

The AHCA failed due to a small handful of Republicans rejecting it, with one part of that handful complaining that it wasn't pulled rightward enough, and the rest actually realizing that going rightward wasn't politically-tenable as you said. Most of the party was totally fine with the AHCA.

This is a somewhat relevant read - https://medium.com/@jamesallworth/the-slow-decay-of-americas...

Basically discussed shift from discussion in politics about democracy to economics.

It's easy for those who aren't affected by those social issues to consider them less important.

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