this post was submitted on 07 Oct 2024
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There wouldn't be an insurance company to tell you no in a single payer system
Damn. That's gonna be really hard to get to in the US. Several steps at least. I'm guessing the next step that we can work for is just guaranteeing universal coverage. But there's gonna be bloody battles over just removing an entire industry from the US market in our lifetime. So I guess this problem is here to stay, even if we're lucky enough to get guaranteed coverage regardless of employment.
It's actually very easy. Force all insurance companies to segregate their health insurance. Nationalise all health insurance.
That's what I'm saying is going to be the hard part. Force the industry to gut themselves. Aren't they the ones paying for our politicians careers? If it were that simple, why hasn't it been done already?
Yup. Which politicians are going to vote to make lobbying illegal?
Yeah that's what the ACA was supposed to do. Until it got neutered and eventually destroyed.
The whole premise was based on the three-legged stool:
Problem is, a stool with three legs is pretty stable, until you shorten or remove one or more, like the individual mandate or the tax subsidies, the whole thing topples over.
One problem was the carrier responsibility leg was too short. Should have been more aggressive in making sure that premiums could not out-pace inflation or otherwise rise over a certain threshold year-over-year.
The other problem is the welfare gap that gets created when you have the individual mandate and not enough funding for Medicare/Medicaid subsidies. You end up with a big chunk of otherwise healthy people who now are forced to either buy (very expensive and not employer sponsored) health insurance, or face a significant tax penalty. The people who got stuck in the middle were rightfully pissed off.
(And surprise surprise, the ones that got stuck in the middle were largely in red states, because they wanted to starve the medicaid beast).
But of course, instead of fixing it by upping the subsidies, we fixed it by removing the individual mandate. In other words, instead of putting a matchbook under the short leg, we completely removed the squeaky one. Now the whole damn stool is falling over and nobody wants to catch it.