Comment by dogemaster2028
2 months ago
Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.
The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative states. And Republicans in Congress removed the individual mandate, which enabled healthy people to go without coverage, raising prices for everyone else.
It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity.
You shouldn't change all the parts in an engine to different specifications at the same time.
The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward.
The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!)
The previous system was broken. The current system is less broken. It's possible to create an even less broken future system.
The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'
In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward.
Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work) was that the bold changes of Obamacare left too many victims behind who ended up worse off.
You have to start with the principles of the country and work with them in mind, if you expect to be successful. You also have to assume future change will be dependent on the political winds of the future.
There is likely a lesson somewhere here about introducing “lean healthcare” style of changes instead of “big bang,” but I haven’t taken the time to articulate them.
Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.
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The Supreme Court is not “a political opponent.” It’s literally the way the country works. It found the requirements for states to participate to be unconstitutional. In fact, it was also SCOTUS who eventually determined in 2012 that the individual mandate penalty was functioning as a tax for constitutional purposes. This was the basis for upholding the law. The mandate itself was not upheld under the Commerce Clause but survived because the financial penalty was deemed a tax.
> The ACA had its most effective cost-control mechanisms stripped by its political opponents.
Because of lobbyism, healthcare sector is extremely strong politically and don't want to reduce their income, Democrats aren't immune to that they have mostly been just as pro corporate as the republicans are they just are pro different corporates.