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Comment by exabrial | Hacker News Reader

Repeal Obamacare, go back to HSAs. Nobody should be taxed on health expenses, which was the whole point of HSAs in the first place. We literally had a budding system that was working and affordable, and it was "fixed".

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If we repeal ACA, we'll need to force insurers to take on patients with preexisting conditions. We can't ice out 38% of Americans[0] from coverage.

[0]: https://www.commonwealthfund.org/publications/issue-briefs/2...

Americans do not care about Americans, and there is no way to design a working system if Americans don't want it because it benefits Americans.

As other commenters have said, pre-existing conditions could and should have been handled separately in a single issue bill, separate from existing insurance. Instead, the truckload of regulations that was brought in around Obamacare has buried health insurance in the US in depths of inefficiency.

Its absurd to drive multi-ton flaming trash truck when all we originally needed was a scooter.

Define "budding system that was working". Before the ACA, the number of uninsured Americans was around 50 million and insurance companies routinely denied coverage or charge higher premiums based on pre-existing health conditions. ACA is not perfect (due in no small part to the concessions that had to be made in congress to get enough votes) but i'd say it's been a net win.

Going back to a pre-ACA system won't lower premiums that much. Medical costs have risen in the last decade, same as any other goods or services, and the way US healthcare is structured, with hospital and doctors negotiating with a profit driven middleman (insurance companies) makes it almost impossible to change the rising premiums.

US healthcare will continue to be a mess until there's a universal healthcare system or single payer system similar to any other developed country on earth.

The ACA didn't do away with HSAs.

ACA didn't do away with HSAs, but the way the Bronze and Catastrophic plans were designed made them incompatible with HSAs. Only this year was that changed. The plans covered certain non-preventive services before the deductible was met, which was not permitted under older HSA rules. It was really dumb, and took 15 years to fix.

Agreed. Upon passage of the ACA my company switched insurance coverage to a High Deductible plan with an HSA. So if anything, the ACA appeared to increase the prevalence of HSA's. But that is my narrow social circle and the grandparent poster seems to have a different experience.

Correct, instead it made them unaffordable and disappeared them out of existence. Previously to ACA, I paid $280/month for a direct (non-employer sponsored) plan that had a $5k deductible. The plan was discontinued as the base fell out.

There is so much wrong with ACA and the hardliners are not capable of self-reflection, and cannot admit that overregulation has done nothing but make things incredibly expensive.

Insurance middle-men have made healthcare expensive. That has nothing to do with the ACA.

do you have anything to say about the fact that before Obamacare, pre-existing conditions were generally not covered? to me that is the main purpose of Obamacare. I think not covering pre-existing conditions is a moral atrocity.

Why does everyone thing that the "one thing" Obamacare did was pre-existing conditions? That is a footnote in the grand scheme of paperwork in unloaded on health insurers. It's one tiny straw in a hayfield of regulations.

I was about to chime in. I still have a HSA? Something interesting is that the ACA was probably making normal people's insurance cheaper because for people with the Medicaid plans were specifically targeted for aggressive coding knowing that the taxpayer was footing the bill

It really does baffle me that the USA continues to subvert "socialism" by taking socialist programs and painting them with a capitalist brush^[1] and creating a worse result for everyone involved. It is the peak of government inefficiency

1: eg: fanny mae, The VA, Medicaid, The Federal Reserve....

Ah, but don't you know? Socialism is evil! Capitalism is GOD and is perfect!

- Republicans pretty much everywhere in the US

Seriously. This is pretty much why single-payer/universal healthcare systems aren't available in the US. It's also why UBI has never been tried. I'm sure someone is going to come in and say that I'm painting an overly-simplistic picture, but we seriously do have people still thinking that people willingly come to the US for healthcare because every other healthcare system is supposedly worse in every imaginable way (which somehow magically proves that what we have is better).

Honestly, I don't think the USA does a terrible job at managing these systems it's just funny to me how the song and dance pretend is such a thin facade. Something like UBI is too idealistic and out of reach for policymakers until the USA moves away from the concept that if you are poor, you are inherently evil.

Really all the USA needs to do is make a fork of the VA healthcare and fix the rough-around-the-edges and start offering it as a well-controlled attractive option in the market that is taxpayer funded, maybe roll it out for union workers and blue collared folk first for maximum political appeal

It was “working” if you didn’t have a pre-existing condition, which could literally be anything the insurance company wanted it to be.

Isn’t idea of insurance at odds with the idea of a pre-existing condition? Like car insurance is a hedge against a crash. We don’t let people buy it after totaling their car.

We really need an alternative system to cover pre-existing and not force it into insurance.

Yes--the only thing ACA did right was force insurers to take on people with pre-existing conditions. All the other crap could be done away with and we would all be better off. I think we should do away with publicly traded healthcare companies like UNH, too. It's a huge conflict of interest to have billionaires involved.

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