The law of large numbers. Spreading risk across a larger pool allows for stabilization of rates. As more people drop coverage predictability decreases. You also get adverse selection when younger people drop coverage and the unhealthy make up the bulk of policyholders which increases the costs for everyone.
Additionally, when you have healthcare you are more likely to go to regular checkups and report minor complaints before they turn into major disease. It is more cost effective to treat disease early rather than wait for it to become debilitating. Healthy people stay in the workforce.
It's also cost effective to let those untreated issues continue to be untreated by people who can't afford it. I'd actually have more empathy if most people weren't living such unhealthy lifestyles in the first place.
The goal is to go back to the old way with preexisting conditions. Remember how much better healthcare was when if your company got bought by another company you would have to reapply for health insurance and every ailment you currently had and were getting treatment for under the old plan are now "preexisting conditions"?
If you have employer sponsored coverage, you are in a different risk pool and this puts downward pressure on your costs as there will be less demand for healthcare with the same supply.
If thats true then why did my health insurance go up so much when ACA went into effect? And not just a little bit it went up a lot! This past year I just gave up and dropped health insurance altogether I can no longer afford it.
So despite the fact that the lack of coverage still kills people and drives others into bankruptcy, we shouldn't try to improve it because it could be worse...
>Having health insurance even subsidized does not mean you can afford to use it as the study I link demonstrates...
It means 2/3rds of people can. Which is tens of millions more people than could afford healthcare before the ACA.
But you don't really care about that, do you? You're just going to reply to this comment with some bullshit quip about the ACA not being perfect, which no one has even come close to arguing, because all you're interested in is attacking it.
Oh I agree, but the fact I'm getting downvoted for even pointing out the flaws of the system kind of shows you have to slow walk some people to the obvious conclusion...
Can you name a developed country that "did it right". Everyone got free (taxpayer funded) medical with NO issues? I was just watching one of my Vanlife shows on Youtube. Brit, he had an inflamed wisdom tooth that needed to come out and he showed us what happened. He went to the NHS and they told him it would be a 6month wait, and then he went to a private dentist and paid cash and they said it would be 3 days wait. Now in the States, Texas where I live there are at least 10 dentists within a 1 mile drive of my house and they will see you right then and there for cash. I know because I have had to have 3 different procedures in the past 3 years. All of them cost me about $1000 average per visit. An extraction and 2 crowns. The extraction was a wisdom tooth, same issue that guy had and that was on the cheaper end at $600.
Everyone complains about the Canadian healthcare system but it works. Pain in the ass for routine stuff since you have to wait but if you have an emergency or even a serious concern, you're getting immediate world class care.
Look no further than Wendell Potter, a former vice-president of Cigna. He wrote on Twitter that Cigna spent big money trying to sell Americans on the lie that the Canadian public health-care system is "awful" and the U.S. system is "much better."
My parents have dual US/Canadian citizenship and would generally agree. The Canadian system definitely isn’t perfect but it’s way better than the US system. The only way the US system works better is if you have lots of money to pay for the best care, which is basically how everything works in the US.
My friends who live in Toronto don't speak ill of it, but then again, they have a pretty good income and use private much of the time. I ask them, why are you paying all those taxes then?
Why should you pay for schools if you don't have kids?
Because schools provide the basis for a lot of things you personally will need. Without universal grade schooling, suddenly, the only people who can join any white collar profession are the children of the rich. The rich have the lowest birth rates. So where is your doctor coming from if the poor kids can't get into college in the first place? Where are your civil engineers going to come from? Where are your nurses going to come from?
The United States federal government spends more money on healthcare per person per year than the Canadian government does.
We already spend enough tax dollars on healthcare to cover the costs of implementing a system that is exactly identical to what they have in Canada, our money just doesn't go as far because we are stuck dealing with a middleman (insurance companies) that provides no real value while also having incredible influence on prices.
If you care about paying fewer taxes you should be against our current system. Around 28% of what the federal government spends is spent on (for-profit) healthcare. It's a complete racket.
Lmao framing this like you got 'em with some kind of zinger is really funny when you realize more tax money is spent on healthcare per capita in the US than in Canada.
I live in the USA in a decent sized city and I have incredible healthcare coverage, it still takes me a year+ to get in for some specialty appointments. This idea that the American healthcare system gives me instant access while only other countries have to wait is just a false narrative.
If doctors are available to see walk ins it means they have empty schedules and could be seeing more patients, but the USA would prefer less people are able to see doctors so people who are better off have easier access.
I have never waited more than a month for anything including surgeries. I went in for carpel tunnel and the guy wanted to do the surgery later that week. I said "wait, at least give me time to set this up with my job" because I arm was in a sling for about a month and I couldn't use it. At the time I delivered big copy machines on a truck so needed the arm, and they had to get helpers for me. I could still program them. They did the surgery 2 weeks later.
Yeh I pay cash for allot of medical, so ya know the saying "Cash is King". The goal really is to make this affordable, NOT less affordable so everyone can afford it, just like everyone can afford a cell phone, which in the 90's was a luxury only for the rich. We gotta make that happen in medical.
Making procedures $20k because you want to create scarcity in the market by limiting the number of surgeons in the USA does not create more access nor lower prices. If the market was deciding, it would be like Lasik, $1000 bucks, 1 time cost. My insurance alone is $1100 a month, plus I am paying cash for anyone that can make it happen right away.
What all these "Fake free systems" have done, is made an entire cottage industry where people who are successful have access to paid doctors, and this is in every single country that claims to have free medical, creating a 2 tier system. One that works, cash based and then the one for the Plebs with long waiting times and artificially created scarcity.
I seriously ask myself how long can this "Free Health Care scam" keep going but ya know, people still falling for Socialism 100 years now, even after its complete collapse in the 1990's World Wide.
What you just described for that Youtuber seems to be a system that functions as expected. Everyone receives coverage at no/low cost during point of care (because it's funded through taxes). However if the patient is unwilling to wait, they can get private care much quicker if they are willing to pay out of pocket.
It’s not “instead of” insurance and solid provider access. Supplemental insurance and expanded provider access should always remain an option. Universal basic healthcare would lower costs and improve access for all Americans.
I can do that over here in sweden too. Let me know how it goes when you have a serious illness that requires surgery or long term treatment. Good luck jumping through the hoops of medical insurance.
So you are saying that guy didn't have a tooth problem and didn't try to goto NHS, and instead paid cash for the work? Thats all fake is what you are saying?
It doens't exist anywhere on Earth. Its just another Leftist pipe dream thats going up in smoke, just like everything else they ever supported. I am beginning to think that we just live in a world of scammers and everything is some kind of scam. I would like to just pay cash for something "1 TIME" and 1 time only, and be done with it. Pay as a go, would be better actually. I got Dental insurance because the Dentist recommended it. What a moron, she was getting cash every visit and now she gets NADA from me, the reason. She dropped my insurance. Imagine telling an establish patient that been going there for 10 years. Hey get insurance and then you lose that customer because you won't take the insurance. All this is so moronic actually.
The statistics show that the 'illegals' are paying more in taxes than the benefits they are pulling. A report just came out for the period 1992 to 2025 demonstrating this. I think it is a few links down in this sub actually ;)
We give israel $4 billion. In California alone illegals are costing taxpayers $9 billion. Thats more than mexicans get in free healthcare in their own country.
And would they be costing so much if we actually had universal healthcare, instead of insurance parasites running a racketeering organization to keep humans from getting healthcare?
Israel funds their free healthcare in part on the money that we give them, taken from our taxpayers. Then, we Americans pay for our own healthcare three times: in taxes, to the insurance agencies, and to the medical practice.
It isn't undocumented people forcing us to pay three times: it's American oligarchs. Bring out the guillotines and health prices would drop like a stone.
94% of everyone in the America has healthcare illegal or otherwise, and illegals who belong to other countries do get free healthcare at the cost of 10's of billions of dollars annually by taxpayers.
Yeah just omit the fact that those undocumented migrants are also tax payers and as a class undocumented migrants pay more in taxes than they receive in benefits at all levels of government.
They don’t deserve to collect they stole wages from Americans and they still get free medicaid and healthcare. They cost more to have then they give to the country.
And what plans have your party of choice put forward to that end? Considering you sound like GOP voter. What has the GOP ever done for working people and their healthcare needs?
OK so you edited your post to make it a bit less xenophobic. Good, perhaps you recognize that "foreigners" contribute as well. Your link shows that California offers free coverage to low income people. They just don't exclude the "illegals". Quick reminder, since you conservatives hate the constitution, the constitution does not differentiate between legal and illegal.
So you dont like what California is doing to spend their taxpayers money, I don't like that my taxes go to support red welfare states either. I guess that makes us even.
The only handouts I see are the ones going to "you people" states.
California can do with their tax money whatever they want.
Newsflash: it takes a certain kind of person to up and move countries to make a better life for their kids. Lazy people stay home, like you, and complain.
Nah, my oath is to the constitution of this country. I just dont understand why you guys hate it so much. Real patriots do the work, not talk the talk.
There's tons of data to show that the government subsidizing Healthcare reduces the costs for everyone yet this administration is hell bent on doing the exact opposite.
This president also inquired about drinking bleach to fight Covid and his followers call him a genius. I wouldn’t look for rational decision making decision making from these people
Oh sorry, he meant injecting "disinfectants" and "light" into the body instead of "bleach" by name. Thank you so much for the clarification. His words sound so much more intelligent now
THE PRESIDENT: Right. And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning.
WTF do you think he's implying man, just because he doesn't say the exact words doesn't mean he wasn't implying injecting disinfectant
“And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?”
This manages to fact check while burying the lede that he mused about whether it would be effective to inject a disinfectant, and thinks it’s such a brilliant idea that he tells the expert to work on it. Only after he’s asked the direct question and the expert denies injecting bleach is a good idea does he walk it back.
Snopes trying to both sides it to be "one of the good ones":
Trump
>And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning.
(Reporter asks to clarify he isn't talking about injecting disinfectants)
>It wouldn't be through injection. We're talking about through almost a cleaning, sterilization of an area. Maybe it works, maybe it doesn't work. But it certainly has a big effect if it's on a stationary object.
Good, done, he misspoke doesn't fully point out/explain he did but corrects it. Except later:
>I was asking a question sarcastically to reporters like you just to see what would happen … I was asking a sarcastic, and a very sarcastic, question to the reporters in the room about disinfectant on the inside. But it does kill it, and it would kill it on the hands and that would make things much better. That was done in the form of a sarcastic question to the reporters.
Why laugh off a slip up while talking, which happens all the time for talk that's complicated/unfamiliar for the speaker, when you can say actually you were never wrong, it's the lib media, they should kill themselves, and injecting disinfectants does kill it?
Because those costs are simply masked not reduced. The government continues paying for it with tax money and debt issuance. More debt issuance generates more inflation by devaluation of currency. Devaluation of currency results in the same people who need these subsidies in the first place becoming more impoverished for to their money getting weaker.
Listen, my job has gone the ICHRA route like many companies have apparently been doing. Instead of having a plan the company pays for they simply offer a subsidy themselves to an employee to go to the ACA to buy coverage. The minimum level of plan a month from the ACA was like $500 and had dog shit coverage. The most expensive plan was $1,200+/month.
My employer was offering a subsidy of $330 so my monthly with the lowest quality insurance would've been $170. However the out of pocket cost was 40% of all fees in a hospital. Sure it covered medication etc but anything really serious I would've been fucked.
The affordable care act was supposed to reign in prices. The expanded subsidies that brought more people in during the COVID lockdowns & unemployment is what Democrats were trying to extend. Because originally those people weren't supposed to be covered by the ACA since they should've had employer coverage.
So this did was supercharge insurance agencies charging the government more money. Worse, many of these plans were never actually used even if the premium was $0 due to govt subsides because of my first point. Garbage plans with high out of pocket costs dissuading use. So they basically got free money from the government without providing actual healthcare.
Yes. The WH administration can make hay about Pharma lowering prices (which is good regardless) but what they aren’t addressing are the PBMs. They control pricing on both sides of the equation and can do it to extortion levels. Pharma (in most cases) have to sell to a PBM (which ends in one price) and then the PBM sells to some distributor (at a different price). In most cases the PBM is also the distributor and in some cases the marketer as well, oh and the insurance payor, even the doctor. This vertical capture enables them to negotiate (with advantage) with Pharma, payors, governmen, and distributors.
If you want to learn more go investigate Cigna/Caremark or OptiumRX/UHC.
Thats part of it. We also have super high tarriffs on medical devices from China, drugs, licensing quotas for physicians and nurses so there will always be just barely enough to keep their salaries sky high. We also have "Non-compete" districts that are called Hospital Districts that have boards there decide how many physicians in that area, how many MRI machine, etc, once again to increase scarcity and keep prices sky high. Actually there is probably about 10,000 regulations I could repeal over this.
If you're taking about Pharmacy Benefit managers I'd have to delve more deeply into how they work and their overall effects on the drug market place before I could answer. I think at a base level they play some part in pricing the only question is how much.
As far as drug pricing go you still have to settle to basic supply/demand/cost economics.
If I make a drug that costs me $35/unit and sell it for $50 and make $15 of profit. But if due to supply side changes my costs rise to $40 or $45 I have incentive to increase my price to continue making the same level of profit as before. So I would normally raise the price to $55 or $60.
But what happens when these single payer systems say they won't accept or buy for a price higher than $50? Or they go even lower and day $45. After all people's lives depend on this. What happens when due to supply chain issues I simply can't reduce the cost any further.
Well shit I'm out of luck and eventually go out of business or run into shortages due to price controls. But wait a second, this other country that doesn't use a single payer system and doesn't price control exists that also buys my product. So sure this single payer system will only buy it at $45 effectively covering only my base costs.
So instead of losing $15/unit in a single payer system I simply charge the non single payer system the losses from elsewhere. Instead I'll increase their price per unit to $75-80 to recover it. That's before you get to all the middle man negotiating and add on costs like marketing, packaging, tariffs, regulations etc.
Which is why Trump pushing for drug prices in the US to be lowered to match the overseas costs. Which is a good first step in a long climb of reigning in fiscal abuse of the customer in healthcare.
Or hear me out here. If the single payer buy refuses to acknowledge cost increases that has risen so the current price would mean selling at a loss, that Pharma company would either pull it from the market or the buyer would simply remove it from the list of subsidized medications.
That's how it really works. American big pharma has healthy profit margins in Europe. Naturally not as high as in the US, due to them having to bargain with a single buyer.
The narrative of US subsidizing Europe with this or that is such a factually incorrect idea it's bordering on laughable.
US multinationals pushes this idea as hard as they can. They absolutely hate that they are being held to higher standards, laws and regulations in Europe.
A lot of valid points. I do agree that the ACA isnt perfect by any means. My point was more just generalizing that removing these subsidies is only going to make the Healthcare cost issue even worse for everyone.
In a perfect world, we'd cut out the insurance middle man and go to a universal payer Healthcare system but we all know thats a pipe dream in America.
Healthcare costs suck even with the ACA. What the subsidies going away can mean is renewed vigor in actually addressing the problem. It's good that some Democrats at least acknowledge these issues. Though I agree with Republicans and Trump getting customer choice back into the market can help alleviate some of the issues it cannot do it all. I certainly don't agree with their HSA style shenanigans and I've suggested alternatives to my own representative and senators.
A universal single payer system has its own set of issues. From retaining skilled people to properly getting materials so care isn't rationed. And yes, I think reducing and gutting insurance middle men is a good idea. The problem lies in how do we reign in exorbitant costs and ensure levels of care are adequately handled.
No Healthcare system is going to be perfect and have flaws. There's going to be pretty exorbitant costs no matter which system is used. My opinion is that getting rid of the insurance aspect is the better option because we arent paying for insurance company profits and lining CEO pockets.
Hey, how about a Free Market in heath care? Has anyone tried that one yet? I am talking about one that doesn't set licensing quotas for physicians or regulations on equipment, all this stuff that introduces scarcity and high prices. Is there anywhere on Earth they have this? Maybe Singapore or China, dunno?
You make many good points, but I have to note that we currently have rationing in the health care system. It;s on the basis of economic ability rather than need. What that has done is create an incentive for wasteful (but remunerative) investment by many hospital systems and doctor's offices. One example, on a per-capita basis US has around 4 times the MRI's that Canada has. However, MRI machines in Canada have a utilization rate about 300% higher then in the US. The result is that the per-use cost is about 1/4 of that in the US. As to single payer system's, it is pretty well documented that the overhead cost is about 5-7% of the cost of delivered medical services. In the US, the overhead of insurance companies and medical billing is around 20-25%. While I don't think single payer is necessarily the best strategy for the US, the reality is that it is a far more efficient system.
Which for the record was a tax even though it was repeatedly campaigned on not being one. Second it was effectively a tax on existing as a human being. It never should've been a thing in the first place.
I'm not arguing whether the mandate was good or bad, I'm just saying that it was a part of the original plan that made it more viable than it is without it.
Just curious though...
Do you have health insurance now?
If so, are your current health insurance premiums "a tax on existing as a human being"?
In countries with public healthcare the citizens all pay taxes to have healthcare and seem to enjoy it. I'm not aware of any country that's ever moved away from public healthcare once they've had it.
"However the out of pocket cost was 40% of all fees in a hospital. Sure it covered medication etc but anything really serious I would've been fucked."
Which is ironic because that's sort of exactly the opposite of how insurance is supposed to work. It is a means of hedging against catastrophic risk. The idea of insurance covering day to day stuff like a doctor's check up doesn't make a ton of sense. You can't insure against something routine, that's not how insurance works.
Of course you also can't insure against events that have already happened (pre-existing conditions) but here we are.
Which is why we need to shift healthcare to a more preventative model then reactionary. One suggestion I made it any healthcare insurance provider accepting subsidies to cover a plan must show that plan was used. Which means doctors visits etc to check stuff that can be an issue. If the plan isn't used then the company would be obligated to pay those subsidies back to the government. Because why would the government pay for services that aren't rendered?
I'm confused by your statement. An important part of the ACA was the provision that preventative care is covered at 100%. That is for every policy even the shitty policies. Once an issue is found then it becomes diagnostic and your deductible kicks in. Is that not a preventative model?
Very much agree with the last point, it was a legit concern from the Republicans. At this point, we might as well overhaul the whole system, rather than just applying the band-aid. But of course, the insurance industry is trillions in size and employ hundreds of thousands of people, so it's always easier said than done.
I don’t disagree with your point on there are a lot of bad plans out there that are just existing on government subsidies (most catastrophic care plans fall into this). These were supposed to be outlawed by the ACA but ongoing legislation weakened these protections and let these plans back in. They are terrible coverage and simply rob people of care, yet they sell as a soundbite on the “news.” The ACA has been weakened I’ve the years rather than strengthened as a the starting point it was. Both political parties are guilty of not trying to improve things for Americans.
Not all locals are bad plans. If you live in cities your options are generally better than rural. If you live in certain states your options can generally be better too. Ive seen ACA plans that are are affordable (or equivalent to open market) with good as coverage as many employer sponsored plans.
The feds spend a lot on healthcare - comparable to other countries which actually have a true universal healthcare system, yet without the ability to cover all residents. America has a completely broken system.
Speaking of adding to the deficit ... how's that going in 2026 with no healthcare for millions? Apparently we have other priorities than healthcare for our citizens? Like extracting all available profit from citizens in worship of corporations and billionaires? Cool, cool.
One thing I noticed that was pretty interesting ... Republicans are consistently calling Americans "consumers" instead of "citizens". I don't think other countries look at it that way.
The ACA was designed to be revenue neutral. The later elimination of various taxes associated with it along with the insurance mandate changed that.
There's a good write up at the KFF: https://www.kff.org/affordable-care-act/health-policy-101-the-affordable-care-act/?entry=table-of-contents-how-have-the-aca-marketplaces-changed-over-time
And the CBO: https://www.cbo.gov/publication/45447
You’re either being purposefully misleading or you don’t understand the data.
There’s no evidence that the ACA, or ACA premiums, actually lowered the cost of healthcare spending in aggregate. The fact that it failed to address the actually underlying causes, like Medicare regulations that drive hospital consolidation, made it so that it was just a bandaid that helped out the poor and middle class and didn’t actually address the problem
Isn't this by design? The GOP cuts subsidies. Makes ACA coverage more expensive. People drop out. Which makes it more expensive. More people drop out. And so on. Until eventually it just implodes.
GOP gets to say, 'See? Universal Healthcare doesn't work.'
Sure we could totally argue semantics about cutting versus not extending and, semantically, you are correct. Call it what you will. But practically, the effect is the same. Make it more expensive deliberately to destroy it.
As someone from a country that has an exceptional Universal Healthcare system that puts the US to shame, it saddens me that you don't understand how Universal Healthcare systems work.
So I would like to see a strictly government option like any one could pay to be in Medicaid. It was a part of Obama’s original proposal but he had to make a deal with the devil (insurance and drug companies) to pass ACA. The cost could be based upon income. If it were cheaper than private insurance, private insurance would have to reduce costs or go broke. Also if there were a single national mandate for coverage you could reduce the administrative cost in healthcare. Administrative costs are approximately 30% and deal with what is covered or not covered by all the different insurance. Throwing more money at it is not the answer. Even Bernie Sanders agrees with that. His argument is that we need the subsidies now because it’s not a problem that can be fixed immediately.
So yes that was the original plan. The problem is that there is no mandate any more. So in theory your healthy pool that was supposed to level off cost is just going uninsured. It’s like 15% are uninsured now. So basically we have made it mandatory to insure the sickest so that pool has grown but the healthy pool is now less.
The mandate impacted a relatively small number of people - 5-10M - I believe this is smaller than the number who have gained coverage through expanded subsidies that were passed under COVID. I have not seen evidence that this group is sicker
Ok I’m not arguing any point I’m just stating what the original mandate was for but if you don’t have 15% of the healthy population paying for insurance that they barely use then I would guess it would affect the price to a certain extent. Now with that being said do I think insurance takes advantage and maybe jacks up the price more than needed? Absolutely they do. They are a business that is what business does, try to make as much profit as possible.
Bro my health insurance for my family has gone up seven thousand dollars in the last two years. 5k increase in 2025, increasing another 2k on 2026. Hundreds of dollars more per paycheck. In addition to a 300 dollar increase per month in my mortgage since I bought the house in 2023. Not to mention all other cost of living increases.
We needed a public option yesterday. This country’s healthcare system isn’t just retarded, it’s killing innocent people everyday and it’s because of corporate greed. Not doctors, not nurses, not anything related to actually practicing medicine - instead it’s the same thing fucking us everywhere it seems. The greed of the rich cannot be satisified, and for that reason they must be put in their place.
The ACA was dead the moment Republicans passed the Tax Cuts and Jobs act in 2017 (purely on party lines) that removed the mandate penalties. They are just beating a dead horse removing these additional tax incentives and funding. The value proposition will die over time as the population can no longer afford ACA plans and the risk gets increasingly worse.
Low risk population has very little financial incentive to buy insurance making the remaining risk pool very high cost.
Some large payers (CVS) have pulled out of the ACA market entirely as it’s not profitable to sell insurance to the risk pool.
Most people get health insurance through their employers. California mandates coverage for everyone to prevent healthier individuals from opting out, which would raise premiums by leaving only the sick insured.
The problem is that most states don't do that and the personal mandate was removed from the ACA by the GOP.
Now as the risk pool is shrinking as people drop coverage due to costs, the costs are going to go up for everyone, not only people covered by the ACA.
This is a problem with trying to lower healthcare costs in a country with a privatized healthcare system, you have to have a large body of healthy young people willingly buying coverage or else costs go up.
Yup, I just dropped out last year. Approaching middle aged, but I'm not paying $500 a month for the chance to pay $10000 a year if I can maneuver the system correctly to start to get the benefit of having paid all that money.
Most young people still get their insurance through their employers.
People who paid the penalty due to the individual mandate were a fraction of a fraction of the overall population (something like 5-10M people, in a country of 220+ million adults).
That’s not exactly true. People can have more than one coverage type at a time. Calculating payor mix by covered lives is tricky because of this. But a rough calculation of employer paid is about 53%. While a rough calculation of self-paid (about 10%) and all forms of public combined (about 43%) equal 53%. About 8% are uninsured at any given time. Employer paid ove the last 5 years has declined while public has ticked up.
Note it doesnt total 100% because people can have two (or more) types of coverage at the same time, the data is always moving (people going on and off coverage) and just plain error.
If you look at it from spend then the numbers swing the other way. About 30% is private and 70% is public.
Net-net: The US healthcare system (by spend) is already a national system it’s just highly fragmented. Wed be better off with a system like Canada, Australia with a public option and private insurance.
That’s not exactly true. People can have more than one coverage type at a time. Calculating payor mix by covered lives is tricky because of this. But a rough calculation of employer paid is about 53%. While a rough calculation of self-paid (about 10%) and all forms of public combined (about 43%) equal 53%. About 8% are uninsured at any given time. Employer paid ove the last 5 years has declined while public has ticked up.
Note it doesnt total 100% because people can have two (or more) types of coverage at the same time, the data is always moving (people going on and off coverage) and just plain error.
If you look at it from spend then the numbers swing the other way. About 30% is private and 70% is public.
Net-net: The US healthcare system (by spend) is already a national system it’s just highly fragmented. Wed be better off with a system like Canada, Australia with a public option and private insurance.
How about this: next time we are having a financial calamity in America, rather than spend the money to provide liquidity to the banking system, allow the banking system to slow way down, but not shut down completely, and spend that money on establishing health care coverage for every US citizen instead. Make that permanent.
Allow the things that break in our economic system, outside of health care for our citizens, to naturally heal themselves. Note: big benefit to companies as well: no longer having to foot the bill for employee health insurance premiums.
So can anyone name a system that some other country uses that is great? Free to use, good service, quick? Anyone, anyone, or do Doctors just SUCK the World over?
I wasn't aware that the US was trying to choke off Sweden. This is what I found about their healthcare system. For reference 1000 SED is about $110 USD at the current exchange rate. So according to the website listed here, you pay about $100-300 out of pocket up front for whatever it is, but the rest should be covered by the taxpayers.
It makes sense you take 10 million people that are currently paying a premium and you take them out of the pool and everybody else has the bear those expenses. Republicans are constantly breaking the insurance markets.
Millions rely on ACA + 70+ million on Medicare + 40+ million SNAP (or used to be). Even if there's 100% overlap between the two, if the people in this country who experience food insecurity and need assistance with healthcare actually voted they would own our government.
hearmeout29 | 7 hours ago
The law of large numbers. Spreading risk across a larger pool allows for stabilization of rates. As more people drop coverage predictability decreases. You also get adverse selection when younger people drop coverage and the unhealthy make up the bulk of policyholders which increases the costs for everyone.
seldom_r | 6 hours ago
Additionally, when you have healthcare you are more likely to go to regular checkups and report minor complaints before they turn into major disease. It is more cost effective to treat disease early rather than wait for it to become debilitating. Healthy people stay in the workforce.
discosoc | 39 minutes ago
It's also cost effective to let those untreated issues continue to be untreated by people who can't afford it. I'd actually have more empathy if most people weren't living such unhealthy lifestyles in the first place.
GhostofBeowulf | 6 hours ago
If only anyone within the GOP had an ounce of common sense... Or you know, a soul.
(I know I know normative beliefs in a rationalist economic system yadaya...)
CliftonForce | 5 hours ago
I have had MAGA scream at me literally that
"MY premiums are to pay for MY Healthcare and NOBODY ELSE'S!!"
They do not know how insurance works. Maybe they think it is like an old magazine subscription, where you get a discount for paying in advance.
saltyjello | 6 hours ago
They are knowingly breaking the system on purpose, it’s not due to ignorance.
BroughtBagLunchSmart | 5 hours ago
The goal is to go back to the old way with preexisting conditions. Remember how much better healthcare was when if your company got bought by another company you would have to reapply for health insurance and every ailment you currently had and were getting treatment for under the old plan are now "preexisting conditions"?
Zepcleanerfan | 5 hours ago
Thank a republican!
IceEateer | 5 hours ago
Not so much a law of large numbers, it's more of a "moral hazard" thing.
Stress_Living | 4 hours ago
*Increases costs for everyone who uses the ACA.
If you have employer sponsored coverage, you are in a different risk pool and this puts downward pressure on your costs as there will be less demand for healthcare with the same supply.
moonshotorbust | 9 minutes ago
If thats true then why did my health insurance go up so much when ACA went into effect? And not just a little bit it went up a lot! This past year I just gave up and dropped health insurance altogether I can no longer afford it.
Responsible-Room-645 | 7 hours ago
Compared to every other developed country, ACA “medical coverage” is an absolute joke, and STILL it’s too much for the GOP to give Americans.
pangea_lox | 6 hours ago
We should have basic universal healthcare like every other modern country. ACA was intended as a stopgap. We need a bigger step toward that.
No_Power1121 | 6 hours ago
You can thank Joe Lieberman for that.
nockeenockee | 6 hours ago
This joke keeps millions of us from bankruptcy and death too.
demipopthrow | 6 hours ago
and millions others are still suffering
MagicBlaster | 5 hours ago
So despite the fact that the lack of coverage still kills people and drives others into bankruptcy, we shouldn't try to improve it because it could be worse...
nockeenockee | 5 hours ago
Ok let’s make it better. But let’s not pretend this system is not a core component to millions of people’s wellbeing.
MagicBlaster | 5 hours ago
Let's also not pretend that the system works, 1/3 of people right are avoiding or postponing care because they cannot afford it.
Just under half say they have trouble affording the care they are getting.
The system fundamentally does not work and we can do better...
nockeenockee | 5 hours ago
But it works and was working much better with extended subsidies.
MagicBlaster | 5 hours ago
Having health insurance even subsidized does not mean you can afford to use it as the study I link demonstrates...
Kindly-Eagle6207 | 4 hours ago
>Having health insurance even subsidized does not mean you can afford to use it as the study I link demonstrates...
It means 2/3rds of people can. Which is tens of millions more people than could afford healthcare before the ACA.
But you don't really care about that, do you? You're just going to reply to this comment with some bullshit quip about the ACA not being perfect, which no one has even come close to arguing, because all you're interested in is attacking it.
RumblinBowles | 5 hours ago
absolutely certain that's not implied in their comment
Zepcleanerfan | 5 hours ago
This is the "worse"
MagicBlaster | 5 hours ago
Oh I agree, but the fact I'm getting downvoted for even pointing out the flaws of the system kind of shows you have to slow walk some people to the obvious conclusion...
CannyGardener | 5 hours ago
Here you go: Immigrants’ Recent Effects on Government Budgets: 1994–2023 : r/Economics
BeautifulFickle3896 | 6 hours ago
Can you name a developed country that "did it right". Everyone got free (taxpayer funded) medical with NO issues? I was just watching one of my Vanlife shows on Youtube. Brit, he had an inflamed wisdom tooth that needed to come out and he showed us what happened. He went to the NHS and they told him it would be a 6month wait, and then he went to a private dentist and paid cash and they said it would be 3 days wait. Now in the States, Texas where I live there are at least 10 dentists within a 1 mile drive of my house and they will see you right then and there for cash. I know because I have had to have 3 different procedures in the past 3 years. All of them cost me about $1000 average per visit. An extraction and 2 crowns. The extraction was a wisdom tooth, same issue that guy had and that was on the cheaper end at $600.
Responsible-Room-645 | 6 hours ago
I’m a Canadian, our healthcare system isn’t perfect but it’s light years ahead of the United States, regardless of what Fox News tells you.
PicoRascar | 5 hours ago
Everyone complains about the Canadian healthcare system but it works. Pain in the ass for routine stuff since you have to wait but if you have an emergency or even a serious concern, you're getting immediate world class care.
Look no further than Wendell Potter, a former vice-president of Cigna. He wrote on Twitter that Cigna spent big money trying to sell Americans on the lie that the Canadian public health-care system is "awful" and the U.S. system is "much better."
That says something.
munky3000 | 6 hours ago
My parents have dual US/Canadian citizenship and would generally agree. The Canadian system definitely isn’t perfect but it’s way better than the US system. The only way the US system works better is if you have lots of money to pay for the best care, which is basically how everything works in the US.
BeautifulFickle3896 | 6 hours ago
My friends who live in Toronto don't speak ill of it, but then again, they have a pretty good income and use private much of the time. I ask them, why are you paying all those taxes then?
Brokenandburnt | 6 hours ago
Because they care about the stability of their society and the wellbeing of the less fortunate?
meatyvagin | 6 hours ago
Yeah, why pay taxes for firemen when my houses isn't actively burning down?
saintsithney | 6 hours ago
Try thinking holistically.
Why should you pay for schools if you don't have kids?
Because schools provide the basis for a lot of things you personally will need. Without universal grade schooling, suddenly, the only people who can join any white collar profession are the children of the rich. The rich have the lowest birth rates. So where is your doctor coming from if the poor kids can't get into college in the first place? Where are your civil engineers going to come from? Where are your nurses going to come from?
Adventurous-Ad8267 | 4 hours ago
The United States federal government spends more money on healthcare per person per year than the Canadian government does.
We already spend enough tax dollars on healthcare to cover the costs of implementing a system that is exactly identical to what they have in Canada, our money just doesn't go as far because we are stuck dealing with a middleman (insurance companies) that provides no real value while also having incredible influence on prices.
If you care about paying fewer taxes you should be against our current system. Around 28% of what the federal government spends is spent on (for-profit) healthcare. It's a complete racket.
GravelLot | 2 hours ago
Lmao framing this like you got 'em with some kind of zinger is really funny when you realize more tax money is spent on healthcare per capita in the US than in Canada.
PM_me_your_skis | 6 hours ago
I live in the USA in a decent sized city and I have incredible healthcare coverage, it still takes me a year+ to get in for some specialty appointments. This idea that the American healthcare system gives me instant access while only other countries have to wait is just a false narrative.
If doctors are available to see walk ins it means they have empty schedules and could be seeing more patients, but the USA would prefer less people are able to see doctors so people who are better off have easier access.
BeautifulFickle3896 | 6 hours ago
I have never waited more than a month for anything including surgeries. I went in for carpel tunnel and the guy wanted to do the surgery later that week. I said "wait, at least give me time to set this up with my job" because I arm was in a sling for about a month and I couldn't use it. At the time I delivered big copy machines on a truck so needed the arm, and they had to get helpers for me. I could still program them. They did the surgery 2 weeks later.
PM_me_your_skis | 6 hours ago
Glad you don't have to wait, doesn't mean the system is working like that for everyone.
BeautifulFickle3896 | 6 hours ago
Yeh I pay cash for allot of medical, so ya know the saying "Cash is King". The goal really is to make this affordable, NOT less affordable so everyone can afford it, just like everyone can afford a cell phone, which in the 90's was a luxury only for the rich. We gotta make that happen in medical.
Making procedures $20k because you want to create scarcity in the market by limiting the number of surgeons in the USA does not create more access nor lower prices. If the market was deciding, it would be like Lasik, $1000 bucks, 1 time cost. My insurance alone is $1100 a month, plus I am paying cash for anyone that can make it happen right away.
What all these "Fake free systems" have done, is made an entire cottage industry where people who are successful have access to paid doctors, and this is in every single country that claims to have free medical, creating a 2 tier system. One that works, cash based and then the one for the Plebs with long waiting times and artificially created scarcity.
I seriously ask myself how long can this "Free Health Care scam" keep going but ya know, people still falling for Socialism 100 years now, even after its complete collapse in the 1990's World Wide.
mclumber1 | 6 hours ago
What you just described for that Youtuber seems to be a system that functions as expected. Everyone receives coverage at no/low cost during point of care (because it's funded through taxes). However if the patient is unwilling to wait, they can get private care much quicker if they are willing to pay out of pocket.
pangea_lox | 6 hours ago
It’s not “instead of” insurance and solid provider access. Supplemental insurance and expanded provider access should always remain an option. Universal basic healthcare would lower costs and improve access for all Americans.
BeautifulFickle3896 | 6 hours ago
So which country did this right?
MagicBlaster | 5 hours ago
So we're shouldn't even try to improve our system because no one has a perfect system?
SalamancasLastDing | 6 hours ago
I can do that over here in sweden too. Let me know how it goes when you have a serious illness that requires surgery or long term treatment. Good luck jumping through the hoops of medical insurance.
Lemp_Triscuit11 | an hour ago
"I was just watching this dude that lives in a van on youtube and now I know about all the healthcare in the world"
I used to wonder how we got where we are, then I realized your vote counts as much as mine lol
BeautifulFickle3896 | 47 minutes ago
So you are saying that guy didn't have a tooth problem and didn't try to goto NHS, and instead paid cash for the work? Thats all fake is what you are saying?
CautiousMagazine3591 | 7 hours ago
We could “give it” to every American if there weren’t millions of illegal foreigners who weren’t getting it for free.
EDIT: "illegal"
apk | 7 hours ago
that’s not true at all, but i’m sure the GOP will give everyone free healthcare as soon as all the “foreigners” are gone 🤡
thatsonlyme312 | 7 hours ago
As a "foreigner", where is this free insurance you speak of? I'd love to sign up
BeautifulFickle3896 | 6 hours ago
It doens't exist anywhere on Earth. Its just another Leftist pipe dream thats going up in smoke, just like everything else they ever supported. I am beginning to think that we just live in a world of scammers and everything is some kind of scam. I would like to just pay cash for something "1 TIME" and 1 time only, and be done with it. Pay as a go, would be better actually. I got Dental insurance because the Dentist recommended it. What a moron, she was getting cash every visit and now she gets NADA from me, the reason. She dropped my insurance. Imagine telling an establish patient that been going there for 10 years. Hey get insurance and then you lose that customer because you won't take the insurance. All this is so moronic actually.
thatsonlyme312 | 5 hours ago
I'm not an expert, but you seem hate free market capitalism.
That has nothing to do with the leftist or foreigners.
CautiousMagazine3591 | 6 hours ago
ACA state exchanges.
PM_me_your_skis | 6 hours ago
The costs of ACA plans is through the roof bud
CautiousMagazine3591 | 6 hours ago
Largely because we are financing other countries poor with free health insurance.
CannyGardener | 6 hours ago
The statistics show that the 'illegals' are paying more in taxes than the benefits they are pulling. A report just came out for the period 1992 to 2025 demonstrating this. I think it is a few links down in this sub actually ;)
CautiousMagazine3591 | 6 hours ago
yeah, find it.
MagicBlaster | 5 hours ago
We both know you're not going to read it, but here it is.
CautiousMagazine3591 | 5 hours ago
You people keep linking the exact same thing so try reading this that article does not refer to illegal immigrants.
Why can’t you people figure your stuff out before repeating yourself incessantly.
Brokenandburnt | 6 hours ago
Bot, shill, or victim of far-right propaganda?
saintsithney | 6 hours ago
We're funding Israel's free healthcare.
CautiousMagazine3591 | 6 hours ago
We give israel $4 billion. In California alone illegals are costing taxpayers $9 billion. Thats more than mexicans get in free healthcare in their own country.
saintsithney | 5 hours ago
And would they be costing so much if we actually had universal healthcare, instead of insurance parasites running a racketeering organization to keep humans from getting healthcare?
Israel funds their free healthcare in part on the money that we give them, taken from our taxpayers. Then, we Americans pay for our own healthcare three times: in taxes, to the insurance agencies, and to the medical practice.
It isn't undocumented people forcing us to pay three times: it's American oligarchs. Bring out the guillotines and health prices would drop like a stone.
uncle-iroh-11 | 4 hours ago
Do you know what the average profit margin of insurance companies is? And their average denial rates?
saintsithney | 4 hours ago
Do you know what I paid for an uninsured ambulance ride, ER stay, and meds in Norway?
$40.36.
Do you know what I paid for the same thing with full insurance in the US?
$3,157.
I could have booked a flight to Norway and a week's stay at Farris Bad Spa for less.
CSMegadeth | 6 hours ago
Luckily we don't do that, so you know, stop lying.
CautiousMagazine3591 | 6 hours ago
Yes we do, educate yourself.
CSMegadeth | 6 hours ago
Provide your evidence. Hitchen's Razor applies here.
Sufficient_Fish_283 | 6 hours ago
He provided a link proving you wrong, so you just attack him instead of arguing on merit, you people are so dense it's sad.
hammerofspammer | 6 hours ago
It’s too bad we can’t give the conservatives a fucking lick of sense
Pockydo | 6 hours ago
Even if that were true and the reason we all know the reps wouldn't let it happen
They'd rather give that money to the oligarchs for kick backs
CautiousMagazine3591 | 6 hours ago
It is true.
Haggardick69 | 6 hours ago
The us doesn’t even provide free healthcare to its citizens much less it’s non-citizens.
CautiousMagazine3591 | 6 hours ago
94% of everyone in the America has healthcare illegal or otherwise, and illegals who belong to other countries do get free healthcare at the cost of 10's of billions of dollars annually by taxpayers.
Haggardick69 | 6 hours ago
Yeah just omit the fact that those undocumented migrants are also tax payers and as a class undocumented migrants pay more in taxes than they receive in benefits at all levels of government.
CautiousMagazine3591 | 6 hours ago
That is a bold lie, America subsidizes illegals lives living here, they are a net burden to the country.
SmegmaCurds | 6 hours ago
They pay into social security and medicaid but can never collect.
CautiousMagazine3591 | 6 hours ago
They don’t deserve to collect they stole wages from Americans and they still get free medicaid and healthcare. They cost more to have then they give to the country.
Haggardick69 | 6 hours ago
Well explain how that can be when the net effect on the countries finances is fiscal surplus?
CautiousMagazine3591 | 6 hours ago
Again read what the CATO institute said. Illegals are a net expense to the country not a positive one.
Pockydo | 6 hours ago
Well im convinced
dubiouscoffee | 6 hours ago
And what plans have your party of choice put forward to that end? Considering you sound like GOP voter. What has the GOP ever done for working people and their healthcare needs?
thatsonlyme312 | 5 hours ago
OK so you edited your post to make it a bit less xenophobic. Good, perhaps you recognize that "foreigners" contribute as well. Your link shows that California offers free coverage to low income people. They just don't exclude the "illegals". Quick reminder, since you conservatives hate the constitution, the constitution does not differentiate between legal and illegal.
So you dont like what California is doing to spend their taxpayers money, I don't like that my taxes go to support red welfare states either. I guess that makes us even.
CautiousMagazine3591 | 5 hours ago
If you want to house illegals, good for you, but don't complain there isn't any money left for Americans when you people start asking for handouts.
thatsonlyme312 | 4 hours ago
The only handouts I see are the ones going to "you people" states.
California can do with their tax money whatever they want.
Newsflash: it takes a certain kind of person to up and move countries to make a better life for their kids. Lazy people stay home, like you, and complain.
CautiousMagazine3591 | 4 hours ago
It’s not just the state of California do yourself a favor and educate yourself
thatsonlyme312 | 4 hours ago
I really don't care to. Every human being should have access to Healthcare, so I'm not bothered by it at all.
I'm more bothered by the fact that we provide corporate welfare and let the obscenely wealthy get away with not paying their fair share.
It's your choice to be bothered by a very specific group of people, while letting others get a free pass. Just like Jesus would do.
CautiousMagazine3591 | 4 hours ago
OK, then go to their country and get them the free healthcare that they deserve according to you
thatsonlyme312 | 4 hours ago
Nah, my oath is to the constitution of this country. I just dont understand why you guys hate it so much. Real patriots do the work, not talk the talk.
CautiousMagazine3591 | 4 hours ago
That’s rich for someone who is supporting a foreign invasion of this country
Key-Benefit6211 | 6 hours ago
We could also greatly reduce the cost if we did away with ACA.
TheGreatDay | 4 hours ago
Yeah, the cost reductions would be swiftly followed by plans being awful bullshit again, so no thanks.
bot_comment1234 | 6 hours ago
And once we stop sending money overseas, it can be used to help Americans 🤣
NameLips | 7 hours ago
Health insurance is already going up every year, and covering less and less with higher deductibles. This is getting out of hand.
Currently my family plan costs more than my mortgage. And I still have to put the portion they don't cover on a payment plan.
ltbr55 | 8 hours ago
There's tons of data to show that the government subsidizing Healthcare reduces the costs for everyone yet this administration is hell bent on doing the exact opposite.
Gen_Sherman_Hemsley | 7 hours ago
This president also inquired about drinking bleach to fight Covid and his followers call him a genius. I wouldn’t look for rational decision making decision making from these people
dnndrk | 7 hours ago
He also wanted to nuke the hurricane and rake the forest.
Gimme_The_Loot | 3 hours ago
Everyone knows you're supposed to rake the hurricane and nuke the forest
Slight_Dark9430 | 6 hours ago
Some of his followers put bleach into their bodies soon after. That's how stupid is followers are.
FaerieFay | 6 hours ago
And yet he has access to the best medicine on the planet.
If he were a regular person he'd be long dead from whatever happened to his ass in combination with his obvious vascular decline.
And a life time of amphetamines & hamburgers.
Check_Me_Out-Boss | 7 hours ago
https://www.snopes.com/fact-check/trump-bleach-covid-19/
IssueOk363 | 7 hours ago
Oh sorry, he meant injecting "disinfectants" and "light" into the body instead of "bleach" by name. Thank you so much for the clarification. His words sound so much more intelligent now
Check_Me_Out-Boss | 7 hours ago
> at no point did Trump explicitly tell people they could or should inject bleach into their bodies.
IssueOk363 | 7 hours ago
THE PRESIDENT: Right. And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning.
WTF do you think he's implying man, just because he doesn't say the exact words doesn't mean he wasn't implying injecting disinfectant
Check_Me_Out-Boss | 7 hours ago
>is there a way we can do something like that
> something like that
IssueOk363 | 7 hours ago
He's literally asking if people can inject themselves with disinfectant. You have to be one dense troll to not see that
I guess you also literally take Jeffrey Epstein's words that "I was Donald Trump's closest friend"
mclumber1 | 6 hours ago
The president is an idiot. We can and should call him out when he does or says stupid things. It's ok. You should do it too. It's therapeutic.
Gen_Sherman_Hemsley | 7 hours ago
“And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?”
The quote speaks for itself
YoohooCthulhu | 7 hours ago
This manages to fact check while burying the lede that he mused about whether it would be effective to inject a disinfectant, and thinks it’s such a brilliant idea that he tells the expert to work on it. Only after he’s asked the direct question and the expert denies injecting bleach is a good idea does he walk it back.
Check_Me_Out-Boss | 7 hours ago
He also asked if we could use UV light to disinfect, which the NYC subway began doing less than 30 days later.
Worriedlytumescent | 7 hours ago
Inside people? Interesting. Can I see that technology? donald trump's a moron. Stop trying to convince people otherwise.
Brokenandburnt | 5 hours ago
Damn, I need VC cash stat, got an investment idea!
Hear me out: UV emitting buttplugs to flog at the next RNC!
I'm gonna make all the money! 💰
RetardedWabbit | 7 hours ago
Snopes trying to both sides it to be "one of the good ones":
Trump >And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning.
(Reporter asks to clarify he isn't talking about injecting disinfectants)
>It wouldn't be through injection. We're talking about through almost a cleaning, sterilization of an area. Maybe it works, maybe it doesn't work. But it certainly has a big effect if it's on a stationary object.
Good, done, he misspoke doesn't fully point out/explain he did but corrects it. Except later:
>I was asking a question sarcastically to reporters like you just to see what would happen … I was asking a sarcastic, and a very sarcastic, question to the reporters in the room about disinfectant on the inside. But it does kill it, and it would kill it on the hands and that would make things much better. That was done in the form of a sarcastic question to the reporters.
Why laugh off a slip up while talking, which happens all the time for talk that's complicated/unfamiliar for the speaker, when you can say actually you were never wrong, it's the lib media, they should kill themselves, and injecting disinfectants does kill it?
Butane9000 | 7 hours ago
Because those costs are simply masked not reduced. The government continues paying for it with tax money and debt issuance. More debt issuance generates more inflation by devaluation of currency. Devaluation of currency results in the same people who need these subsidies in the first place becoming more impoverished for to their money getting weaker.
Listen, my job has gone the ICHRA route like many companies have apparently been doing. Instead of having a plan the company pays for they simply offer a subsidy themselves to an employee to go to the ACA to buy coverage. The minimum level of plan a month from the ACA was like $500 and had dog shit coverage. The most expensive plan was $1,200+/month.
My employer was offering a subsidy of $330 so my monthly with the lowest quality insurance would've been $170. However the out of pocket cost was 40% of all fees in a hospital. Sure it covered medication etc but anything really serious I would've been fucked.
The affordable care act was supposed to reign in prices. The expanded subsidies that brought more people in during the COVID lockdowns & unemployment is what Democrats were trying to extend. Because originally those people weren't supposed to be covered by the ACA since they should've had employer coverage.
So this did was supercharge insurance agencies charging the government more money. Worse, many of these plans were never actually used even if the premium was $0 due to govt subsides because of my first point. Garbage plans with high out of pocket costs dissuading use. So they basically got free money from the government without providing actual healthcare.
Stinkycheese8001 | 7 hours ago
Someone recently mentioned that a huge part of the out of control costs is the role of PBMs etc. would you say that is a factor?
joepez | 7 hours ago
Yes. The WH administration can make hay about Pharma lowering prices (which is good regardless) but what they aren’t addressing are the PBMs. They control pricing on both sides of the equation and can do it to extortion levels. Pharma (in most cases) have to sell to a PBM (which ends in one price) and then the PBM sells to some distributor (at a different price). In most cases the PBM is also the distributor and in some cases the marketer as well, oh and the insurance payor, even the doctor. This vertical capture enables them to negotiate (with advantage) with Pharma, payors, governmen, and distributors.
If you want to learn more go investigate Cigna/Caremark or OptiumRX/UHC.
BeautifulFickle3896 | 6 hours ago
Thats part of it. We also have super high tarriffs on medical devices from China, drugs, licensing quotas for physicians and nurses so there will always be just barely enough to keep their salaries sky high. We also have "Non-compete" districts that are called Hospital Districts that have boards there decide how many physicians in that area, how many MRI machine, etc, once again to increase scarcity and keep prices sky high. Actually there is probably about 10,000 regulations I could repeal over this.
Butane9000 | 7 hours ago
If you're taking about Pharmacy Benefit managers I'd have to delve more deeply into how they work and their overall effects on the drug market place before I could answer. I think at a base level they play some part in pricing the only question is how much.
As far as drug pricing go you still have to settle to basic supply/demand/cost economics.
If I make a drug that costs me $35/unit and sell it for $50 and make $15 of profit. But if due to supply side changes my costs rise to $40 or $45 I have incentive to increase my price to continue making the same level of profit as before. So I would normally raise the price to $55 or $60.
But what happens when these single payer systems say they won't accept or buy for a price higher than $50? Or they go even lower and day $45. After all people's lives depend on this. What happens when due to supply chain issues I simply can't reduce the cost any further.
Well shit I'm out of luck and eventually go out of business or run into shortages due to price controls. But wait a second, this other country that doesn't use a single payer system and doesn't price control exists that also buys my product. So sure this single payer system will only buy it at $45 effectively covering only my base costs.
So instead of losing $15/unit in a single payer system I simply charge the non single payer system the losses from elsewhere. Instead I'll increase their price per unit to $75-80 to recover it. That's before you get to all the middle man negotiating and add on costs like marketing, packaging, tariffs, regulations etc.
Which is why Trump pushing for drug prices in the US to be lowered to match the overseas costs. Which is a good first step in a long climb of reigning in fiscal abuse of the customer in healthcare.
Brokenandburnt | 5 hours ago
Or hear me out here. If the single payer buy refuses to acknowledge cost increases that has risen so the current price would mean selling at a loss, that Pharma company would either pull it from the market or the buyer would simply remove it from the list of subsidized medications.
That's how it really works. American big pharma has healthy profit margins in Europe. Naturally not as high as in the US, due to them having to bargain with a single buyer.
The narrative of US subsidizing Europe with this or that is such a factually incorrect idea it's bordering on laughable.
US multinationals pushes this idea as hard as they can. They absolutely hate that they are being held to higher standards, laws and regulations in Europe.
ltbr55 | 7 hours ago
A lot of valid points. I do agree that the ACA isnt perfect by any means. My point was more just generalizing that removing these subsidies is only going to make the Healthcare cost issue even worse for everyone.
In a perfect world, we'd cut out the insurance middle man and go to a universal payer Healthcare system but we all know thats a pipe dream in America.
Maxpowr9 | 5 hours ago
Why so many people didn't get raises at the end of 2025. The COLA was to cover the crazy increase in health insurance premiums.
Butane9000 | 7 hours ago
Healthcare costs suck even with the ACA. What the subsidies going away can mean is renewed vigor in actually addressing the problem. It's good that some Democrats at least acknowledge these issues. Though I agree with Republicans and Trump getting customer choice back into the market can help alleviate some of the issues it cannot do it all. I certainly don't agree with their HSA style shenanigans and I've suggested alternatives to my own representative and senators.
A universal single payer system has its own set of issues. From retaining skilled people to properly getting materials so care isn't rationed. And yes, I think reducing and gutting insurance middle men is a good idea. The problem lies in how do we reign in exorbitant costs and ensure levels of care are adequately handled.
ltbr55 | 7 hours ago
No Healthcare system is going to be perfect and have flaws. There's going to be pretty exorbitant costs no matter which system is used. My opinion is that getting rid of the insurance aspect is the better option because we arent paying for insurance company profits and lining CEO pockets.
BeautifulFickle3896 | 6 hours ago
Hey, how about a Free Market in heath care? Has anyone tried that one yet? I am talking about one that doesn't set licensing quotas for physicians or regulations on equipment, all this stuff that introduces scarcity and high prices. Is there anywhere on Earth they have this? Maybe Singapore or China, dunno?
Brokenandburnt | 5 hours ago
Did or didn't Obama try to add collective bargaining or the government doing the bargaining with ACA, but couldn't get the votes?
Or is that something I've dreamt or confused with something?
NYDCResident | 6 hours ago
You make many good points, but I have to note that we currently have rationing in the health care system. It;s on the basis of economic ability rather than need. What that has done is create an incentive for wasteful (but remunerative) investment by many hospital systems and doctor's offices. One example, on a per-capita basis US has around 4 times the MRI's that Canada has. However, MRI machines in Canada have a utilization rate about 300% higher then in the US. The result is that the per-use cost is about 1/4 of that in the US. As to single payer system's, it is pretty well documented that the overhead cost is about 5-7% of the cost of delivered medical services. In the US, the overhead of insurance companies and medical billing is around 20-25%. While I don't think single payer is necessarily the best strategy for the US, the reality is that it is a far more efficient system.
botblue | 6 hours ago
>The affordable care act was supposed to reign in prices.
The ACA included the individual mandate which was abolished in Trump's first term.
Removing a key component of the ACA and then claiming "it's broken" is certainly one way to break it.
I'm not claiming ACA was ever perfect, but it's not viable without the individual mandate.
Butane9000 | 6 hours ago
Which for the record was a tax even though it was repeatedly campaigned on not being one. Second it was effectively a tax on existing as a human being. It never should've been a thing in the first place.
pgold05 | 4 hours ago
Money can be used to pay for good and services.
botblue | 2 hours ago
I'm not arguing whether the mandate was good or bad, I'm just saying that it was a part of the original plan that made it more viable than it is without it.
Just curious though...
Do you have health insurance now?
If so, are your current health insurance premiums "a tax on existing as a human being"?
In countries with public healthcare the citizens all pay taxes to have healthcare and seem to enjoy it. I'm not aware of any country that's ever moved away from public healthcare once they've had it.
DrawPitiful6103 | 7 hours ago
"However the out of pocket cost was 40% of all fees in a hospital. Sure it covered medication etc but anything really serious I would've been fucked."
Which is ironic because that's sort of exactly the opposite of how insurance is supposed to work. It is a means of hedging against catastrophic risk. The idea of insurance covering day to day stuff like a doctor's check up doesn't make a ton of sense. You can't insure against something routine, that's not how insurance works.
Of course you also can't insure against events that have already happened (pre-existing conditions) but here we are.
Butane9000 | 7 hours ago
Which is why we need to shift healthcare to a more preventative model then reactionary. One suggestion I made it any healthcare insurance provider accepting subsidies to cover a plan must show that plan was used. Which means doctors visits etc to check stuff that can be an issue. If the plan isn't used then the company would be obligated to pay those subsidies back to the government. Because why would the government pay for services that aren't rendered?
hearmeout29 | 7 hours ago
I'm confused by your statement. An important part of the ACA was the provision that preventative care is covered at 100%. That is for every policy even the shitty policies. Once an issue is found then it becomes diagnostic and your deductible kicks in. Is that not a preventative model?
ImperiumRome | 7 hours ago
Very much agree with the last point, it was a legit concern from the Republicans. At this point, we might as well overhaul the whole system, rather than just applying the band-aid. But of course, the insurance industry is trillions in size and employ hundreds of thousands of people, so it's always easier said than done.
joepez | 6 hours ago
I don’t disagree with your point on there are a lot of bad plans out there that are just existing on government subsidies (most catastrophic care plans fall into this). These were supposed to be outlawed by the ACA but ongoing legislation weakened these protections and let these plans back in. They are terrible coverage and simply rob people of care, yet they sell as a soundbite on the “news.” The ACA has been weakened I’ve the years rather than strengthened as a the starting point it was. Both political parties are guilty of not trying to improve things for Americans.
Not all locals are bad plans. If you live in cities your options are generally better than rural. If you live in certain states your options can generally be better too. Ive seen ACA plans that are are affordable (or equivalent to open market) with good as coverage as many employer sponsored plans.
Successful-Money4995 | 7 hours ago
Clearly there are people for whom cost is not reduced because they have to subsidize others.
Increased efficiency would actually reduce costs and that might be a side effect of having a single payer system.
Also, cost is not the only variable, we're also trying to improve health.
Ralwus | 7 hours ago
Federal healthcare spending as a percentage of GDP continues to rise.
Keeper151 | 7 hours ago
This tracks with the average age of the population. Expect it to continue rising for the next couple decades at least.
Ralwus | 6 hours ago
And also tracks with rising healthcare costs.
mclumber1 | 6 hours ago
The feds spend a lot on healthcare - comparable to other countries which actually have a true universal healthcare system, yet without the ability to cover all residents. America has a completely broken system.
Check_Me_Out-Boss | 7 hours ago
Guys, did you know that when someone else pays for something, it lowers the cost for everything utilizing it?!
Not to mention Obama said the ACA would not add to the deficit and would, in fact, reduce it over time.
Sweet_Artichoke_65 | 5 hours ago
Speaking of adding to the deficit ... how's that going in 2026 with no healthcare for millions? Apparently we have other priorities than healthcare for our citizens? Like extracting all available profit from citizens in worship of corporations and billionaires? Cool, cool.
One thing I noticed that was pretty interesting ... Republicans are consistently calling Americans "consumers" instead of "citizens". I don't think other countries look at it that way.
But my points may be lost on you.
mottledmussel | 5 hours ago
The ACA was designed to be revenue neutral. The later elimination of various taxes associated with it along with the insurance mandate changed that.
There's a good write up at the KFF: https://www.kff.org/affordable-care-act/health-policy-101-the-affordable-care-act/?entry=table-of-contents-how-have-the-aca-marketplaces-changed-over-time
And the CBO: https://www.cbo.gov/publication/45447
Stress_Living | 4 hours ago
You’re either being purposefully misleading or you don’t understand the data.
There’s no evidence that the ACA, or ACA premiums, actually lowered the cost of healthcare spending in aggregate. The fact that it failed to address the actually underlying causes, like Medicare regulations that drive hospital consolidation, made it so that it was just a bandaid that helped out the poor and middle class and didn’t actually address the problem
paternoster | 5 hours ago
In the US an entire industry of insurance companies exists solely to be an expensive middle layer between primary care and the end user.
That's it. That's what it's all about. They have very deep pockets and lobby like hell.
ekulzards | 7 hours ago
Isn't this by design? The GOP cuts subsidies. Makes ACA coverage more expensive. People drop out. Which makes it more expensive. More people drop out. And so on. Until eventually it just implodes.
GOP gets to say, 'See? Universal Healthcare doesn't work.'
Br0metheus | an hour ago
It's been the GOP's standard playbook since the 80's:
These fuckers don't deserve air
Check_Me_Out-Boss | 7 hours ago
The GOP didn't cut the subsidies. Democrats did when they passed the 2022 Infrastructure Bill.
Faustus2425 | 7 hours ago
0/10 - they put enhanced subsidies in place that year that were temporary.
EDIT - I realized I am feeding a troll, deleting the rest of this
Check_Me_Out-Boss | 7 hours ago
You mean they set a sunset date for when covid emergency subsidies would end that Republicans refused to extend because covid is over.
ekulzards | 7 hours ago
Sure we could totally argue semantics about cutting versus not extending and, semantically, you are correct. Call it what you will. But practically, the effect is the same. Make it more expensive deliberately to destroy it.
Check_Me_Out-Boss | 7 hours ago
It didn't make it more expensive, it only unhid the real costs.
ekulzards | 7 hours ago
As someone from a country that has an exceptional Universal Healthcare system that puts the US to shame, it saddens me that you don't understand how Universal Healthcare systems work.
Goldeneagle41 | 7 hours ago
So I would like to see a strictly government option like any one could pay to be in Medicaid. It was a part of Obama’s original proposal but he had to make a deal with the devil (insurance and drug companies) to pass ACA. The cost could be based upon income. If it were cheaper than private insurance, private insurance would have to reduce costs or go broke. Also if there were a single national mandate for coverage you could reduce the administrative cost in healthcare. Administrative costs are approximately 30% and deal with what is covered or not covered by all the different insurance. Throwing more money at it is not the answer. Even Bernie Sanders agrees with that. His argument is that we need the subsidies now because it’s not a problem that can be fixed immediately.
bunsNT | 6 hours ago
> Also if there were a single national mandate for coverage you could reduce the administrative cost in healthcare.
Wouldn't one expect then costs to have come down since the ACA passage due to millions of more people having healthcare insurance?
Goldeneagle41 | 6 hours ago
So yes that was the original plan. The problem is that there is no mandate any more. So in theory your healthy pool that was supposed to level off cost is just going uninsured. It’s like 15% are uninsured now. So basically we have made it mandatory to insure the sickest so that pool has grown but the healthy pool is now less.
bunsNT | 6 hours ago
The mandate impacted a relatively small number of people - 5-10M - I believe this is smaller than the number who have gained coverage through expanded subsidies that were passed under COVID. I have not seen evidence that this group is sicker
Goldeneagle41 | 6 hours ago
Ok I’m not arguing any point I’m just stating what the original mandate was for but if you don’t have 15% of the healthy population paying for insurance that they barely use then I would guess it would affect the price to a certain extent. Now with that being said do I think insurance takes advantage and maybe jacks up the price more than needed? Absolutely they do. They are a business that is what business does, try to make as much profit as possible.
DetroitLionsSBChamps | 6 hours ago
Bro my health insurance for my family has gone up seven thousand dollars in the last two years. 5k increase in 2025, increasing another 2k on 2026. Hundreds of dollars more per paycheck. In addition to a 300 dollar increase per month in my mortgage since I bought the house in 2023. Not to mention all other cost of living increases.
It can’t go on like this man
hussainhssn | 5 hours ago
We needed a public option yesterday. This country’s healthcare system isn’t just retarded, it’s killing innocent people everyday and it’s because of corporate greed. Not doctors, not nurses, not anything related to actually practicing medicine - instead it’s the same thing fucking us everywhere it seems. The greed of the rich cannot be satisified, and for that reason they must be put in their place.
7477388287 | 5 hours ago
The ACA was dead the moment Republicans passed the Tax Cuts and Jobs act in 2017 (purely on party lines) that removed the mandate penalties. They are just beating a dead horse removing these additional tax incentives and funding. The value proposition will die over time as the population can no longer afford ACA plans and the risk gets increasingly worse.
Low risk population has very little financial incentive to buy insurance making the remaining risk pool very high cost.
Some large payers (CVS) have pulled out of the ACA market entirely as it’s not profitable to sell insurance to the risk pool.
TGAILA | 8 hours ago
Most people get health insurance through their employers. California mandates coverage for everyone to prevent healthier individuals from opting out, which would raise premiums by leaving only the sick insured.
OrangeJr36 | 7 hours ago
The problem is that most states don't do that and the personal mandate was removed from the ACA by the GOP.
Now as the risk pool is shrinking as people drop coverage due to costs, the costs are going to go up for everyone, not only people covered by the ACA.
This is a problem with trying to lower healthcare costs in a country with a privatized healthcare system, you have to have a large body of healthy young people willingly buying coverage or else costs go up.
Global_Cockroach2324 | 6 hours ago
Yup, I just dropped out last year. Approaching middle aged, but I'm not paying $500 a month for the chance to pay $10000 a year if I can maneuver the system correctly to start to get the benefit of having paid all that money.
bunsNT | 6 hours ago
Most young people still get their insurance through their employers.
People who paid the penalty due to the individual mandate were a fraction of a fraction of the overall population (something like 5-10M people, in a country of 220+ million adults).
joepez | 6 hours ago
That’s not exactly true. People can have more than one coverage type at a time. Calculating payor mix by covered lives is tricky because of this. But a rough calculation of employer paid is about 53%. While a rough calculation of self-paid (about 10%) and all forms of public combined (about 43%) equal 53%. About 8% are uninsured at any given time. Employer paid ove the last 5 years has declined while public has ticked up.
Note it doesnt total 100% because people can have two (or more) types of coverage at the same time, the data is always moving (people going on and off coverage) and just plain error.
If you look at it from spend then the numbers swing the other way. About 30% is private and 70% is public.
Net-net: The US healthcare system (by spend) is already a national system it’s just highly fragmented. Wed be better off with a system like Canada, Australia with a public option and private insurance.
joepez | 6 hours ago
That’s not exactly true. People can have more than one coverage type at a time. Calculating payor mix by covered lives is tricky because of this. But a rough calculation of employer paid is about 53%. While a rough calculation of self-paid (about 10%) and all forms of public combined (about 43%) equal 53%. About 8% are uninsured at any given time. Employer paid ove the last 5 years has declined while public has ticked up.
Note it doesnt total 100% because people can have two (or more) types of coverage at the same time, the data is always moving (people going on and off coverage) and just plain error.
If you look at it from spend then the numbers swing the other way. About 30% is private and 70% is public.
Net-net: The US healthcare system (by spend) is already a national system it’s just highly fragmented. Wed be better off with a system like Canada, Australia with a public option and private insurance.
Nuvuser2025 | 7 hours ago
How about this: next time we are having a financial calamity in America, rather than spend the money to provide liquidity to the banking system, allow the banking system to slow way down, but not shut down completely, and spend that money on establishing health care coverage for every US citizen instead. Make that permanent.
Allow the things that break in our economic system, outside of health care for our citizens, to naturally heal themselves. Note: big benefit to companies as well: no longer having to foot the bill for employee health insurance premiums.
Remove 3rd party. Let “AI” do it (/s).
BeautifulFickle3896 | 6 hours ago
So can anyone name a system that some other country uses that is great? Free to use, good service, quick? Anyone, anyone, or do Doctors just SUCK the World over?
Brokenandburnt | 5 hours ago
Sweden's system is still decent even though our (not insane) Conservative minority government are doing their best at choking the budget.
BeautifulFickle3896 | 4 hours ago
I wasn't aware that the US was trying to choke off Sweden. This is what I found about their healthcare system. For reference 1000 SED is about $110 USD at the current exchange rate. So according to the website listed here, you pay about $100-300 out of pocket up front for whatever it is, but the rest should be covered by the taxpayers.
https://legalclarity.org/is-healthcare-in-sweden-free-for-everyone/
Zebra971 | 5 hours ago
It makes sense you take 10 million people that are currently paying a premium and you take them out of the pool and everybody else has the bear those expenses. Republicans are constantly breaking the insurance markets.
TheHomersapien | 5 hours ago
Too bad they don't vote.
Millions rely on ACA + 70+ million on Medicare + 40+ million SNAP (or used to be). Even if there's 100% overlap between the two, if the people in this country who experience food insecurity and need assistance with healthcare actually voted they would own our government.
But they don't vote. And Republicans know that.