Donald Trump is about to face a rude awakening over Obamacare

[sugartitty]

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated that he may keep two of the law’s most popular provisions. One is straightforward enough - children up to the age of 26 being allowed to stay on their parents’ plan. The other - preventing insurance companies from denying coverage

Comments

[molkat]

Good article. It's complicated, and you can't cherry pick what you like with ACA. There's also the issue with eliminating how companies are compensated based on their risk pool. Company A and B attracted a relatively healthy population, Company C's population is very high risk. Per ACA A & B must pay into a pool, and that will be distributed to C. It helps to ensure you don't just market yourself to young, healthy people and that your patient population is a mix. The sicker the population the more you'll be compensated.

[amyura]

Unless you do not pass go and head straight to full-on socialism, single-payer, wherein those of us already paying market rate AND healthy essentially end up paying the same amount in taxes as we were in insurance premiums, some rich people pay more in taxes, and everyone has access to health care.

There WOULD still be losers, though-- the health insurance industry employs a LOT of people, from the corporate execs all the way down to the ICS-trained billers. When people talk about saving money, that's the money that would be saved. Those people would be jobless-- but at least they'd still have healthcare under single payer.

But snark aside (I'd love single payer but it's probably not gonna happen in my lifetime), this is a really good article and lays out exactly why things played out the way they did.

[thunderbird8]

I don't think a single-payer system would eliminate private health insurance entirely (don't other countries have some form of it?) though it would no doubt render it far less profitable.

[belleweather]

Almost all countries with single payer still have private insurance. The private insurance covers procedures and drugs that aren't covered by single payer. For example, say you want the new wizz-bang drug for high cholesterol that doesn't actually provide better outcomes, but costs 30x more. Your country's single-payer policy likely doesn't cover it, because generally they cover proven, low-cost therapies. But your private insurance likely will. Or say you want your gallstones out this week, rather than waiting 2-3 weeks and you are in a country without enough hospital beds. Private insurance pays for you to go to a fancy clinic this week, v. a public clinic next month.

In some countries, it's an issue of convenience and fancy-ness (Canada, the UK, much of western europe) In other countries, it's an issue of safety; you can get care at a public hospital, but it's going to be substandard, maybe to the point of being unsafe.

[shadwing]

It would defiantly be smaller than it is right now, in my area alone you can't swing an insurance claim without hitting several medical billing/processing companies doing claim process, authorizations, verifications ect. It's one of the biggest employers around here.

Going single payer won't eliminate those industries but they will have less claims needing to be processed do they WILL be downsized ALOT which means a loss of jobs. Unless the transition includes the shiny new Single payer system absorbing as many of those jobs and infrastructure as possible there will be significant job losses.

[hudebnik]

This article is exactly what I was muttering to myself as I fell asleep last night, having read somewhere that Trump was considering keeping "some parts" of Obamacare, notably the dependents-under-25 clause and the pre-existing-conditions clause. He may not have thought things through far enough to realize on his own why "gotta take all comers" without "comers gotta come" is unsustainable, but I have to think he's enough of a businessman to understand it once thirty or so economists explain it to him.

The interesting question is what he does once he understands the problem. One option is he could keep the unpopular individual mandate (or modify it slightly as suggested by some conservatives, to "you can't be excluded for a pre-existing condition IF you've maintained continuous coverage"). Another option is he could drop the popular pre-existing conditions clause. Third, faced with a choice between doing two unpopular things, he could do neither and rely on his force of will to prevent the inevitable rapid premiums hikes from