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Comment by SV_BubbleTime | Hacker News Reader

I like that only 13 years later after a decade of ranting about it - people are finally understanding on their own why the “Affordable Care Act” was such a bullshit scam entirely supported by insurance providers.

It was even sold in a ridiculous way. “We all know health care is broken, so if we just force everyone to sign up, and give them more guaranteed income streams then it will fix itself!!”.

I don’t want to hear about how Obama actually wanted single payer or X. He knew exactly what it was the whole time.

“Medical billing” is an industry probably larger than medical care.

I fully support Costco here, insurance is a scam.

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It would have been better had the provider constraints not been struck down by the supreme court.

The entire idea was using the threat of losing access to Medicare $$$ to force acceptance of all ACA plans by providers in order to drive down cost negotiations for individual payers.

Large companies get to leverage large group sizes, and the idea of the ACA was to effectively turn all government aligned plans including Medicare into a single giant "all or nothing" group.

But when the courts struck that down, instead it became the exact opposite, allowing for even more division and sub-grouping across ACA plans, which drives up the end payee costs because there's little to no consequences for providers telling ACA plans to get bent.

The ACA as designed was effectively a compromise, and then the courts reversing the key compromise meant the overall result was a hot pile of crap outside of finally ditching preexisting condition lock-in (which was still a win overall, but a much more minor one).

Could you clarify which part of the ACA you are saying was struck down by the Supreme Court?

The only such parts I know of are the mandatory Medicaid expansion and some stuff related to covering contraception. (And the individual mandate penalty was reduced to zero by Congress in 2017.)

I was not aware of any part of the ACA that required insurers to carry certain plans, apart from the general regulations it introduced on health insurance plans in general.

Perhaps the president/congress shouldn’t try to make unconstitutional compromises.

It’s all interpretation though, isn’t it? Unsurprisingly, the Constitution has very little say on the topic of health insurance. How the content of the document gets applied to modern contexts is a matter of enormous debate, in a lot of contexts “unconstitutional” is a moving target.

It used to be the case that anything that the Constitution didn't allow the government to do was considered not allowed. Too bad now it's the opposite - anything the Constitution doesn't explicitly prohibit it to do, it feels free to. And anything it does prohibit - like regulating speech - it does anyway, in a roundabout way. But at least we got all the problems they promised us to solve this way, actually solved, right?

whether or not something is found constitutional just depends on the prudence of the bench. Segregated schools were found constitutional under the same constitution that later found them not to be. The Supreme Court overrules itself all the time; the march of progress is slow: https://www.grunge.com/895625/the-supreme-court-has-overrule...

Please describe how the Affordable Care Act led to the situation you're responding to.

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