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Comment by zdragnar | Hacker News Reader

Ostensibly, the Affordable Care Act was supposed to reduce the average family's premiums by $2,500 a year.

When that didn't happen, the story changed to that number being how much more premiums would have risen.

Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here. Inflation is an obvious one, plus continual introduction of more and more costly treatments- biologic injections, cancer therapies and so forth. The unfortunate increase in obesity rates in my lifetime (along with all the health complications) has been a significant contributor as well.

It all adds up.

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> Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here.

An interesting thing about rising health costs is that it has happened at roughly similar rates in most first world countries for the last 50+ years.

For example in 1990 the UK, FR, and US were paying 2.0, 2.2, and 2.6 times their 1980 costs per capita. By 2000 that was 4.1, 4.1, and 4.2. By 2018 (the last year I had data for when I calculated this a few years ago) it was 10.6, 7.5, and 10.2.

Here's the 2000 to 2018 increase for those and some others: DE, FR, CA, IT, JP, UK, US were 2.1, 1.8, 2.0, 1.7, 2.6, 2.6, 2.3.

When politicians in the US talk about rising health care costs they usually put the blame on recent policies from opposing politicians. That so many first world countries with so many different health care systems all have seen similar increases for the last 50+ years suggests that it is due to something they all have in common and that government policy doesn't affect it much.

The individual mandate part of the ACA was the part designed to reduce premiums. You need healthy participants in any health insurance scheme to subsidize unhealthy people.

That was eliminated by a Republican bill, the Tax Cuts and Jobs Act of 2017.

FWIW the state of california has its own individual mandate.

Yes, and that was years after the ACA took full effect and the rates did not decrease.

Most people get insurance through their employer, and most employer plans (at medium to large companies) are self funded by the company and merely administered by insurance companies.

That means the healthy participants had no effect on those plans whatsoever. Even at peak, the individual mandate had only cut the number of uninsured by half, and the effect on rates was negligible.

In 2010, it was already known the proportion of old to young was increasing, and the proportion of doctors was decreasing.

Prices were always going to increase.

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