Guy from Poland here. What happened to ObamaCare? I thought you got finally a primary healthcare for all?
Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter.
One other thing the ACA did is stop the scourge of scam insurers. This is a thing where people would pay for "insurance" and then find out later that their "insurance" did not actually afford them any meaningful coverage. The ACA tried to close a set of loopholes and overall regulate the insurance market more closely.
Anybody reading this from outside the US probably lives in a place where low-cost healthcare is more accessible than it is in the US.
As point of reference, I lived in Taiwan for years - they have a national health insurance system, and taxes are comparable if not lower in some situations to the United States.
In Germany if you’re mid to high earner, a private insurance can cost you less than half than the public healthcare system and you get much better service. Starting with appointments with specialists, who always give preference to privately insured people.
In this day and age public healthcare system are not efficient and bill the wrong people.
They are mostly payed by young population, between 18 and 65 years old. Specially the highest earners.
However most of the usage comes from 65+ citizens, which are starting to become majority. And also tend to be the ones concentrating the wealth of the country.
These public systems work great when most of the population is young and is paying into the system. But modern western societies are not like that anymore. Wealth is not owned mostly by older people while they barely pay into the system.
Private systems work better because each citizen pays into his old age health coverage during his young years.
The solution here is to get rid of private insurance in Germany and only have public. It creates a two class system and private is a terrible choice once you are older, as costs will skyrocket.
Costs when you get older skyrocket, but not your monthly contribution.
You subsidize your own elderly costs by paying slightly more during your younger years. That slightly more is part of the insurance companies Float, which gets invested and is used 30-40 years later to cover your extra costs in old age.
In a public system there’s no float. Everyone pays to cover the costs of the healthcare for that budget year. Which has the consequence that whenever there are population age shifts, the system becomes not sustainable, which is our current situation in Germany.
If everyone (except unemployed) had private health insurance, population age would be non-problem.
You also ignore that you can't switch and magically have 30-40 years of float for old people currently receive healthcare, so you have to keep the same system in place until they are gone because insurance companies would instantly go bankrupt under your plan (since they have yet to build a float but have payouts instantly), so now young people subsidize old and have to pay for their non-subsidized future so they will basically have to pay double. Or do you plan just leave old people out of the public system? Pretty nice demographic to just ignore in your plan.
This statement is at odds with itself.
I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling.
Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).
It's subsidized, but the new budget has drastically decreased these subsidies and so the cost to enroll in the ACA is about to go up for people who want to get insurance through their marketplace.
You shouldn't change all the parts in an engine to different specifications at the same time.
The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward.
The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!)
The previous system was broken. The current system is less broken. It's possible to create an even less broken future system.
The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'
Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off.
You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future.
There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them.
Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.
I'd trend in the opposite direction. The death of bipartisanship (due to changes in media, education, and gerrymandering: none likely to change soon) render democracies incapable of solving large problems over a multi-voting cycle timespan effectively.
Ergo, the best solution is to punt to an independent body, in the same way central bank management was done.
It makes more sense to have democratically-elected government responsible for and deciding the details, but not the strategic arcs.
Healthcare, national debt / budget deficits, military procurement, voting rights enforcement, education policy would all be better off in consistent hands, even if occasionally less capable ones.
Sometimes, it's more important to keep to an approach than have the optimal approach.
Now? Most democracies get the worst of both worlds there.
Central banking works because problems are instantly catastrophic to the system, whereas healthcare systems are not that fragile. They can survive broken for a long time.
Everybody is okay having a central lender of last resort because the problem is technical, typically unemotional, and in general, benefits every participant equally (because everybody loses is the system collapses).
Healthcare is different in that it affects MY decisions on a regular basis. America is individualistic and self reliant. We never want some government bureaucrat deciding what treatment [I] should or shouldn’t get if [I] can afford it with my own independently earned money. [You] should take care of [Yourself], save your own money, eat healthy, exercise, or not, and live with your consequences.
States have power too. So it does not matter much if some Bernie politician has some fantasy about some central single payer system that has some theoretical average benefit if it restricts ME from making my own choices.
Other countries have other cultures and foundational principles, so Bernie may have better luck there.
But not here.
Is it limiting? Probably for this case. But the fact is the system works for many other things. Everyone wants to come here. It’s the best country in the world etc etc. It does not have to be perfect. But it’s the best we get with the philosophy that made the country what it is.
Does it suck for healthcare? Overall, probably. But not for [ME].
We saw the system has limitations in other cases (think pandemics etc, but even now, many Americans can’t forgive the politicians that kept them imprisoned in their own homes).
You have a right to life, liberty, and pursuit of happiness. But not to anything that must be provided by someone else, like healthcare.
Because of lobbyism, healthcare sector is extremely strong politically and don't want to reduce their income, Democrats aren't immune to that they have mostly been just as pro corporate as the republicans are they just are pro different corporates.
> Short version: Obamacare never turned into “free primary care for everyone,” it was just a bunch of rules and subsidies bolted onto the same old private-insurance maze. It helped at the margins (more people covered, protections for pre-existing conditions), but premiums/deductibles can still go nuclear if you’re in the wrong income bracket, state, or employer situation. From an EU/Poland perspective it’s not a public health system at all, just a slightly nerfed market where you still get to roll the dice every year.
(And I'm not an expert so hopefully people will correct any mistakes)
"Obamacare" was never healthcare for all. It is a GOP healthcare plan that heavily subsidizes private insurance. (Because free markets) And the current affordability crisis is the result of letting the government subsidies that help people pay for their Obamacare coverage lapse.
On a positive note: Obamacare (aka the ACA-PPP) did put some restrictions reasonable restrictions on the terrible things insurance companies used to do. For example, drop customers for "pre-existing conditions", impose lifetime payout maximums, etc.