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Comment by ako | Hacker News Reader

Correlation does not imply causation - is there any proof that obamacare is the cause of the increases in costs, or would that have happened anyways?

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It's very rare to have direct proof of the effect of an economic/regulatory intervention, but luckily, in this case, we do. We've had a decade a survey data that indicates exactly what the effect the ACA had on employer provided healthcare was.

See here for one such example: https://pnhp.org/news/impact-of-aca-on-employers-and-their-e...

Some relevant highlights: * More than one-third of organizations now have increased out-of-pocket limits, in-network deductibles and/or participants’ share of premium costs in response to ACA. More than one in five organizations have increased copayments or coinsurance for primary care, increased participants’ share of prescription drug costs and/or increased the employee proportion of dependent coverage cost. * The excise tax on high-cost group health plans (a.k.a. Cadillac tax) is considered the top ACA cost driver beyond 2015. Since 2011, a steadily increasing percentage of organizations has taken action to avoid triggering the excise tax — a trend likely to continue. More than one in ten organizations already have adopted changes to prevent them from triggering the tax, 21% are working on changes and 28% plan to act sometime prior to 2018. Only one-quarter said changes were not necessary either because they have no high-cost plans (23%) or because they plan to pay the tax (2%).

That being said, the year following the passage of the ACA saw a large anomalous spike in employer healthcare costs that wasn't present in Medicaid/Medicare. It's almost undeniable that this was due to the ACA.

That’s what happens when poorer people who tend to work for employers that don’t offer benefits such as health insurance start getting healthcare.

Someone has to pay for it, and it shows up as increased premiums/deductibles/employer share of premium, but in exchange, we get rid of pre existing condition exclusions, we get in network out of pocket maximums, and older people don’t get hit so hard because younger people have to subsidize their healthcare.

Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:

https://www.statista.com/statistics/720767/medical-cost-tren...

But old people have Medicare. Health insurance for old people hasn't been the problem.

65+ has Medicare. Health problems start in your 40s, and greatly accelerate in 50s. Most Americans have clogged arteries, diabetes, or hypertension and need treatment many years before getting to Medicare age.

This isn't an argument over the merits of the ACA. Many of are fine with Universal Healthcare but not with deluding ourselves into thinking that it's a free lunch. It's a statement of fact intended to address the false premise that we don't know the causal effect of the ACA on various healthcare costs.

We know exactly what it was as we have direct evidence as to what actions employers took in response to it e.g. increased premiums, increased out of pocket minimums, reductions in coverage, etc. The result is that, pound for pound, the same healthcare is more expensive.

> Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:

This is unsupported by the chart. In fact, it shows the opposite: the largest decreases in healthcare spending growth occurred before the passage of the ACA. That aside, the parent comment is seeking the causal effect of the ACA on healthcare costs, not a low correlating trend.

> Correlation does not imply causation - is there any proof that obamacare is the cause of the increases in costs, or would that have happened anyways?

And even if it did, cost isn't the only measure of success. It's main goal was to increase access to medical care, which I understand it was successful at.

That's very.. one dimensional point of view. You can't just call something a success when you made other people worse off in the process and simply ignored it.

> That's very.. one dimensional point of view. You can't just call something a success when you made other people worse off in the process and simply ignored it.

Not really. It made people better off in the way it was designed to do. It was always going to cost more to give more people access to medical care (e.g. those with preexisting conditions). Rather than "making people worse off", it set the trade-off to a different point than it was before.

In theory, it seems plausible that the additional cost of more medical care was more than offset by the economic value of letting people switch jobs more easily, thus spending more time doing things they are better suited to.

As well as the economic value of saving the lives/careers of people who go on to contribute to society in excess of the cost of their treatment.

I'm not saying I've seen a study proving that helping sick people is a net positive for society, in dollars and cents, but it should at least be considered...?

In 2012 Obama promised premiums would go down, my main point was that health insurance is theoretically no longer tied to employment. (note: I am aware that in practice it is not so simple as Obamacare plans are a small fortune)

ACA would have caused insurance prices to rise no matter what since healthcare spending would have risen since more people are getting healthcare since the law required insurers to cover everyone.

People that complain about ACA increasing prices are complaining about having to pay more since more people are getting healthcare. ACA also requires younger people to pay disproportionately more than older people.

Health insurance premiums did go down from infinity to somewhere between $400 per month and $1,200 per month for people who previously couldn’t buy it.

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