The many vague, and poorly thought up economic policies of the far left.

Agema

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Have you considered the context of the conversation?
Have you heard of psychological projection?

You're just accusing me of your own flaws. You cannot explain any coherent or compelling argument for why the ACA made US healthcare overall worse than the previous situation, whilst giving no apparent credit to the substantial improvement in healthcare access for millions of your countrymen. That being the case, what's really got your goat about the ACA? I think there's only one likely answer: your own partisanship.

And Silvanus is absolutely right about what you do when you're losing an argument - as you are here.
 

tstorm823

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You cannot explain any coherent or compelling argument for why the ACA made US healthcare overall worse than the previous situation.
Have you read anything I've written at all? When I say that the ACA made no meaningful difference overall, and codified the status quo, how do you interpret that as "made worse than the previous situation." It's not worse than, it's identical to. Read better.
And Silvanus is absolutely right about what you do when you're losing an argument - as you are here.
I don't lose arguments. An argument is not a debate, it isn't a zero sum game, it is possible for everyone to lose and equally possible for everyone to win. I am willing to concede a point that I was wrong about, at which point even if I was losing, I no longer am. The only way to really lose an argument is to stubbornly insist on being wrong to the bitter end. So maybe stop doing that, you are more than welcome in the winners' circle.
 

Bedinsis

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I mean, I've admitted to being wrong about things on this forum in the past. Draw what conclusions you will from that.
I know. I could see someone being self-centered enough that such instances are rationalized away as "well I had a sound enough reasoning that I practically was correct anyway so I was at the end of the day right either way but people failed to understand me.".
 

Agema

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Have you read anything I've written at all? When I say that the ACA made no meaningful difference overall,
Which is plainly inaccurate, as it improved healthcare access for millions of Americans at little or no cost to government healthcare spending. If you don't think it is a "meaningful difference" to improve the healthcare access for millions of Americans at little or no cost... what conclusions do you want other people to draw from that?

If you want to argue that the US healthcare system needs more radical, root-and-branch reform to vastly improve overall healthcare delivery and/or its efficiency, you can claim the ACA did not achieve that, and I'm sure most people including me here would agree. However, why then also attack the ACA for failing to even achieve its more limited aims? It's irrelevant to that argument. So there's something else going on motivating you to attack the ACA. What is that?

The second obvious thing to then consider is why the ACA occurred rather than more radical reform, and that if the US healthcare system needs radical reform, where is that going to come from? This inevitably leads us to the positions of the political parties on healthcare. I don't think it's outrageous to point out that it is an area the Democrats have been much more active than the Republicans. This is, after all, entirely consistent with Republican rhetoric and ideology of minimal interference in private industry, hostility to government intervention, and general conservative principles of limited change.
 

tstorm823

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Which is plainly inaccurate, as it improved healthcare access for millions of Americans at little or no cost to government healthcare spending. If you don't think it is a "meaningful difference" to improve the healthcare access for millions of Americans at little or no cost... what conclusions do you want other people to draw from that?
Agema, I don't know how you don't get this. The "access" you're describing is people getting insurance. The way people are getting insurance is by paying for it, either themselves or through their employer. People could already do that, most of them already did.

People aren't paying less overall because of the ACA.
People aren't getting better healthcare because of the ACA.

If you want to celebrate broader sharing of risk of expense, go ahead. But everything you've said about more access or lower cost is absolute garbage. Don't be blindsided by the deceptive name, the Affordable Care Act is no more about affordable care than the Inflation Reduction Act was about reducing inflation, these are bill names crafted to garner public support, nothing more. The ACA is industry regulations on health financing, that you may support many of in their own right, but it's not succeeding at making healthcare affordable because that was never actually the goal.
 

Agema

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The "access" you're describing is people getting insurance. The way people are getting insurance is by paying for it, either themselves or through their employer. People could already do that, most of them already did.
Yes, most of them did. But the thing about that "most" is that it indicates a portion of the population that did not have insurance. From memory, this was ~15% underinsured and ~15% uninsured, so ~30% total. Your word salad is just a way of trying to minimise these people existing because you don't want to address it. If the ACA and subsequent increase in insurance cover tells us anything, it's that actually a lot of these people wanted insurance, it's just they couldn't afford it.

And yes, increasing insurance cover increased healthcare access. I don't think your semantic argument "healthcare insurance isn't healthcare access" remotely useful, because it does not engage with healthcare provision in the real world that actually matters. Hence why I call it sophistry.

Your other major attack line of late is just one of the many polite variants on "You are stupid". It is not important to address except to point it out, albeit even then you seem to just double down and say I am too stupid to even identify when I am told I am stupid (#94). Unfortunately for you, it seems I and several other members of the forum are not as stupid as you think.
 
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So much would need to change for universal healthcare to work in a country as large and diverse as the U.S. At the onset we’d have to train everyone how to take better care of themselves and provide universal access to the means to do so, stop putting so much garbage in our foods via megacorps, pesticides, etc. The healthcare industry is already overburdened and understaffed via quantity and quality even without it.

Basically something would have to give just to get the ball rolling, and odds are the first thing ironically would be the highly abused element of convenience. Although OTOH a massive, multifaceted overhaul of so many things would also need to take place to start correcting our many current problems.
 
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Phoenixmgs

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So much would need to change for universal healthcare to work in a country as large and diverse as the U.S. At the onset we’d have to train everyone how to take better care of themselves and provide universal access to the means to do so, stop putting so much garbage in our foods via megacorps, pesticides, etc. The healthcare industry is already overburdened and understaffed via quantity and quality even without it.

Basically something would have to give just to get the ball rolling, and odds are the first thing ironically would be the highly abused element of convenience. Although OTOH a massive, multifaceted overhaul of so many things would also need to take place to start correcting our many current problems.
Yep, I'm for universal healthcare but the way the US currently does healthcare, it's not something that can be done currently. The amount of money we waste on drugs that don't do anything to improve health outcomes is staggering. We've taught people to eat so poorly starting with the "war on fat" to now plant-based meats. It's pretty hard to make the standard fast food combo meal more unhealthy but they found a way by replacing the meat (the one good thing in the whole meal) with something ultra-processed. From a study ending 2016 (so it's probably even worse today), it was shown that 88% of Americans are metabolically unhealthy and that all comes down to diet for the normal person (without some kind of specific disorder that would cause metabolic issues with a proper diet). Being constantly metabolically unhealthy leads to so much disease and chronic conditions. The American health system doesn't get at the root cause and just prescribes drugs to mellow out the symptoms.

Yeah, the food industry makes foods as palatable as chemically possible but you also don't need to buy them either. It's the fault of both sides. The person still has full control of what foods they eat and you can still eat very healthy (it probably costs less money to eat healthier due to eating less food overall). And there should also be more regulations on foods as well and the claims should actually be backed by actual science (like the foods that are horrible for your heart but have on the box that they are heart healthy). Teaching kids in school proper nutrition should be a high priority. When I went to school, they taught us that infamously bad food pyramid that told you to eat the opposite of what you should. Eating healthy is actually really simple and should be something super easy to be taught but it sadly isn't.
 

Chimpzy

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Speaking of vague and poorly thought up economic stuff
 

Dirty Hipsters

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Speaking of vague and poorly thought up economic stuff
Auditing government efficiency and spending is a good idea. No one even knows what the pentagon spends its $800 billion budget on. Billions just randomly disappear and are unaccounted for and no one seems to care.

Putting Musk in charge of something like that is stupid though. The government isn't a business, it's not supposed to be making money, it's supposed to be providing services. People like Musk would cut things like the postal service and the EPA and claim that they waste money by not making a profit. Musk loves cutting "waste" in his businesses and every time it backfires and blows up in his face, like when he cut most of the developers and QA at Twitter and now the site barely works anytime he tries to do a livestream.
 
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Seanchaidh

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Putting Musk in charge of something like that is stupid though. The government isn't a business, it's not supposed to be making money, it's supposed to be providing services. People like Musk would cut things like the postal service and the EPA and claim that they waste money by not making a profit. Musk loves cutting "waste" in his businesses and every time it backfires and blows up in his face, like when he cut most of the developers and QA at Twitter and now the site barely works anytime he tries to do a livestream.
Also, Musk seems to be more of a mascot than an administrator in any case.
 
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Agema

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You conflate making people pay for health insurance with them having access to healthcare. That's real sophistry.
It's not sophistry, because it's true.

The typical way this works is that people on low incomes tend to be better at hitting forms of core, planned payments: rent, bills, major insurance, etc. Then they meet ongoing expenses of necessities, and whatever other luxuries they can afford that fills the rest of their income. Without cover, healthcare ends up in the latter category. Someone feels unwell, they decide whether it's worth affording the medical fees: after all, it may just be a passing illness and if they wait it may go away. Paying an unexpected bill they haven't planned for becomes highly undesirable, especially for what might be a transient sickness. (It might also not be transient, and those weeks-months they put it off could result in severe harm or death.) However, as insurance, healthcare costs move into the former as a planned expense. Once they have cover and the risk of being hit with substantial out of pocket expenses diminishes, instead when they feel ill they seek care. Thus cover facilitates access.

To add to that, where healthcare costs are particularly high, without insurance people often just don't get treated, or get substandard treatment, because the medical provider won't get paid. Sure, they'll patch up an emergency case, but what then? Without payment, nothing. Have you ever watched US medical shows? Did you ever wonder why in shows like Scrubs they featured storylines where they get an uninsured patient, and the hospital tells the doctors to hustle them back out of the door the minute the legal minimum obligation has been done? Healthcare cover equals access.

Worth tying in to this is the fact that out-of-pocket expenses are a major cause of financial hardship including bankruptcy, which insurance tends to mitigate. As above, these out of pocket costs are why people may be inclined to avoid seeking healthcare. Although the ACA may have been less effective than desired in this regard and medical debt is still a massive problem, studies have also suggested that the ACA has reduced medical debt problems to some degree.

Finally, this is also a major reason why the USA has such crummy overall healthcare outcomes on international comparisons despite ranking extremely highly on quality of care (if provided). Because in countries with forms of universal healthcare, where people are not going to be saddled with a massive fee for going to their GP and getting some tests, they're much more likely to go. Yes, their governments are "making people pay" via taxation... and they get better health outcomes for it. Hence also why even with the individual mandate scrapped, low income US citizens are still paying for their subsidised insurance: because they think they'll have better outcomes, too.
 

tstorm823

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Once they have cover and the risk of being hit with substantial out of pocket expenses diminishes, instead when they feel ill they seek care.
No they don't. Money is one of many reasons people don't run to the doctor the moment they feel slightly unwell. America is not interested in your Weenie Hut General.
 

Agema

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No they don't. Money is one of many reasons people don't run to the doctor the moment they feel slightly unwell. America is not interested in your Weenie Hut General.
You can howl at the moon about your mythical vision of what America wants and behaves like, but anyone who cares about policies and their outcomes for real people is much more interested in what the data tells us people actually do. And the data seems to tell us that a lot of them like to get insurance, and then use it to access better healthcare, with better long-term health outcomes.

Deal with it.
 

tstorm823

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You can howl at the moon about your mythical vision of what America wants and behaves like, but anyone who cares about policies and their outcomes for real people is much more interested in what the data tells us people actually do. And the data seems to tell us that a lot of them like to get insurance, and then use it to access better healthcare, with better long-term health outcomes.

Deal with it.
Does it really? Or have you conjured that data in your mind, assuming it to be real.

Here's a fun question: are many new people buying private insurance now than before the ACA? I don't have a simple answer here, I doubt anyone does. There are more people insured than before the ACA, but the employer mandate is still in effect, so millions more people are insured that way. There are millions of people getting insurance through the Marketplace, but how many of them are people who were previously uninsured? The Marketplace is pretty convenient, has most of the private insurers available, and comes with the potential of subsidies. How many of the people getting Marketplace plans were already privately insured before the ACA, and just started going through that portal?

There are fewer people buying their own health insurance now than before the ACA. I did some time-limited googling and looked at specifically working-age populations to set aside people on Medicare. In the 90s, 13% of those under age 65 were buying their own insurance. That number now is 8.6. There's a convenient web portal to buy subsidized health insurance, and people buying their own insurance has decreased by a full third. The employment-based insurance mandate is not only responsible for the increase in the insured, it's eaten away a giant chunk of direct-buy insurance as well.

This data doesn't tell me specifically the intentions of all people, and there is certainly someone somewhere happy to buy their newly subsidized insurance, but when you talk of increased millions of people deciding for themselves to be insured, you're just wrong. The millions more people are getting insurance through their employer, as a government mandated condition of employment, and the payment for it is automatically deducted from their paycheck.
 

Silvanus

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but the employer mandate is still in effect, so millions more people are insured that way.
So what? Why would you exclude one of the primary avenues of receiving insurance, when we're discussing the breadth of insurance coverage?

There are more people insured than before the ACA
This is what matters.

Two questions:
1. In America, Is someone insured more or less likely than someone uninsured to be able to access a healthcare procedure they need?
2. Are more people insured after the ACA?

Answer those questions and you've got your conclusion on healthcare access. You've already answered #2 above.
 

Agema

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Here's a fun question: are many new people buying private insurance now than before the ACA?
Who cares?

The employer mandate was part of the ACA, so if someone gained insurance through it, they gained insurance because of the ACA. The precise distribution of who gained insurance through subsidised personal insurance, or employer mandate, or whatever other ACA mechanism is irrelevant: they all gained insurance, and thus improved healthcare access, because of the ACA.
 

tstorm823

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Who cares?
You: "Millions of your countrymen are choosing to gain health insurance."
Me: "No, it's through employers."
You: "Who cares?"

Why are making specific cases that you don't care about?
So what? Why would you exclude one of the primary avenues of receiving insurance, when we're discussing the breadth of insurance coverage?
Because we aren't discussing only the breadth of insurance. We are discussing the overall impact. Yes, there are some who will benefit from being insured, and others will not. Such is the purpose of insurance. The millions that have "access" because of the ACA is the measurement of those paying in, not the minority that actually benefit. People could always pay for medical care.

The meaningful questions are whether people are healthier and whether they are paying less. If neither of those is significantly true, it's not reasonable to argue that act made healthcare better or more affordable. It made things more uniform, and flattened what people are spending towards the average, and you can support those initiatives if you like, just be honest about it.