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Comment by tptacek | Hacker News Reader

Why would I be excited about a proposal to totally restructure an industry that every American comes into contact with and that represents something approaching 20% of our economy just for the prospect of a ten percent savings? Take any family complaining today about the cost of a Silver plan on an ACA exchange, offer them a 10% savings, and see if they're OK with what they're paying.

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Because it covers millions more, while spending less. Is this difficult to understand?

It leaves us overspending on health care by a huge amount, raises everyone's insurance, and ultimately takes away everyone's employer-provided care, which the majority of Americans who have it like. If it was cutting our expenses in half, the cost savings might sell it. But 10%?

> ultimately takes away everyone's employer-provided care

Really? Even the NHS system allows a parallel employer provided system to run alongside it, it's just only common for higher-paying jobs and those with US parent companies.

Right, the rich will retain private care no matter what. The challenge is what happens to the middle class, the majority of whom have employer-provided care that they actually like (this is a major challenge with any health reform in the US: the status quo has powerful support). There's a near-consensus that the impact to the market for these insurance products will, within a few years, be eliminated by M4A.

> It leaves us overspending on health care by a huge amount

How is that the case when it reduces costs by 10%? Doesn't sound like we'll be spending any more than we already are.

You literally just said "It's not perfect, so I don't want it".

Don't let perfect be the enemy of improvement.

Constant improvement is what the system needs, and anything that improves it is good and should be done.

It's not that it's imperfect, it's that it's insignificant.

If the proposal had no costs, it would obviously be worth pursuing.

But it's a historically disruptive proposal. For changes on that scale, we should be targeting significant fixes. 10% is just nibbling at the edge of the problem --- to put it another way, if the cost savings is 10%, then a few years after the change was enacted, we'd be right back where we are now.

You can't iterate on restructuring the economy; it's not a PHP program. You can iterate on incremental fixes, but that's not what M4A is.

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