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> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions p

> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be

CGMthrowaway 6mo ago
We traded the cruelty of Exclusion for the cruelty of Extraction.
- tptacek 6mo ago
  What does that mean?
  - deleted 6mo ago
    [deleted]
  - CGMthrowaway 6mo ago
    Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
    - raw_anon_1111 6mo ago
      You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
      - CGMthrowaway 6mo ago
        We are talking past each other. When I said moral hazard I'm talking about adverse selection(1), my bad if that was unclear. And I was responding to some comments about denial for pre-existing conditions, which as you point out is irrelevant for continuous coverage group policies. Removing the mandate penalty without also adjusting the pre-existing condition protections did introduce adverse selection in the current regime. None of that disqualifies my argument about the current state of affairs though re the business model of modern insurance companies If you were just looking to shout "dems good GOP bad" and find others who agree with you, that's cool too. (1)https://en.wikipedia.org/wiki/Adverse_selection https://en.wikipedia.org/wiki/Adverse_selection
    - LorenPechtel 6mo ago
      The problem here is that pre-ACA you didn't have insurance, either. Yes, they would (maybe--some plans saw huge sticker shock because the original didn't actually pay much of anything) sell you "insurance". They would offer a plan for a few years, then close it, offer something new. The old plan would see patients getting sick, costs would rise. Premiums were based on costs *for that plan*. Soon the healthy jump ship for something else, now the old plan is only the sick and the premiums go into a death spiral. Thus the reality was that any ongoing problem soon you were uninsured.
    - dragonwriter 6mo ago
      Before ACA, insurance had a more traditional "dump you when you were in need" role that leveraged pre-existing conditions rules by, if you fell ill in a way which was likely to be sufficiently expensive to make this profitable, looking for any minimally tenable evidence of an undisclosed pre-existing condition (just to have something to cite as a pretext, it didn't need to be convincing), using it to justify cancelling your insurance, and avoiding any legal remedy by refunding your entire lifetime of premium payments. Of course, whether or not you actually had a pre-existing condition when you had signed up for the original insurance, you now have one that prevents you from getting new insurance,
deleted 6mo ago
[deleted]
twoodfin 6mo ago
Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?
- raw_anon_1111 6mo ago
  If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. But you do realize that the entire idea of not being able to get insurance because of pre-existing conditions is completely unique to the US? Costa Rica for instance (where I am right now for a month and half) allows anyone to become a resident as long as you have guaranteed income of around $2000 a month or you deposit $60K into a local bank account and they arrange monthly disbursements and you pay 15% of your stated income to CAJA. Healthcare is both better and more affordable here. The same is true for Panama. Why can’t the US figure this out?
  - GenerWork 6mo ago
    >If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. This is a flat out lie. You absolutely could buy health insurance without being at a company.
    - raw_anon_1111 6mo ago
      Not if you had a pre-existing condition - the entire point of this thread.
  - LorenPechtel 6mo ago
    And if you had an expensive dependent better work for a big company. Saw it happen--wife lost her coverage through work because they had an employee with an expensive kid. Next year insurance wasn't offered.
antisthenes 6mo ago
> people have forgotten how bad things used to be Not really, because whereas before things were bad for people with pre-existing conditions, now they are really bad for everyone. People are paying exorbitant prices either for insurance, for routine health care stuff, or for both. There was no free lunch, so we traded some health care for the chronically ill, for slightly less healthcare for everyone else. The insurance companies make sure it's an extractive zero-sum game in terms of actual healthcare provided.
- raw_anon_1111 6mo ago
  When I was looking for healthcare after my employer went tits up right before the ACA went into affect, I couldn’t buy insurance at any price because of a pre-existing condition. Mine you that I have had my ore-existing condition since birth in 1974, had one surgery my entire life - foot surgery in 1996 - and this was 2011 and now I’m 52 and still haven’t had any complications from it and don’t expect to. I was also a part time fitness instructor, runner and could past any of the standardized fitness assessment standards for someone who was 5 years younger as far as push ups, sit ups, running etc. I had a contract so I could have easily paid more based on risk. Before anyone mentions COBRA, that’s only an option if your former group plan still exists and it didn’t when the company went out of business. Just looking, even now the ACA Silver for my wife and I would be around $800 a month in my state. Even ignoring medical costs have gone up more than inflation, that would have been $550 a month in 2011 if the ACA had been available.

CGMthrowaway 6mo ago

We traded the cruelty of Exclusion for the cruelty of Extraction.

tptacek 6mo ago
What does that mean?
- deleted 6mo ago
  [deleted]
- CGMthrowaway 6mo ago
  Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
  - raw_anon_1111 6mo ago
    You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
    - CGMthrowaway 6mo ago
      We are talking past each other. When I said moral hazard I'm talking about adverse selection(1), my bad if that was unclear. And I was responding to some comments about denial for pre-existing conditions, which as you point out is irrelevant for continuous coverage group policies. Removing the mandate penalty without also adjusting the pre-existing condition protections did introduce adverse selection in the current regime. None of that disqualifies my argument about the current state of affairs though re the business model of modern insurance companies If you were just looking to shout "dems good GOP bad" and find others who agree with you, that's cool too. (1)https://en.wikipedia.org/wiki/Adverse_selection https://en.wikipedia.org/wiki/Adverse_selection
  - LorenPechtel 6mo ago
    The problem here is that pre-ACA you didn't have insurance, either. Yes, they would (maybe--some plans saw huge sticker shock because the original didn't actually pay much of anything) sell you "insurance". They would offer a plan for a few years, then close it, offer something new. The old plan would see patients getting sick, costs would rise. Premiums were based on costs *for that plan*. Soon the healthy jump ship for something else, now the old plan is only the sick and the premiums go into a death spiral. Thus the reality was that any ongoing problem soon you were uninsured.
  - dragonwriter 6mo ago
    Before ACA, insurance had a more traditional "dump you when you were in need" role that leveraged pre-existing conditions rules by, if you fell ill in a way which was likely to be sufficiently expensive to make this profitable, looking for any minimally tenable evidence of an undisclosed pre-existing condition (just to have something to cite as a pretext, it didn't need to be convincing), using it to justify cancelling your insurance, and avoiding any legal remedy by refunding your entire lifetime of premium payments. Of course, whether or not you actually had a pre-existing condition when you had signed up for the original insurance, you now have one that prevents you from getting new insurance,

deleted 6mo ago

[deleted]

twoodfin 6mo ago

Why is that inherently bad? Should I be able to buy fire insurance on pre-existing embers?

raw_anon_1111 6mo ago
If you live long enough, you will have a pre existing condition. The way it was suppose to work with the original mandate is that everyone had to be insured either through their employee or the exchange. So you couldn’t just buy insurance when you were sick. The Supreme Court struck that down. If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. But you do realize that the entire idea of not being able to get insurance because of pre-existing conditions is completely unique to the US? Costa Rica for instance (where I am right now for a month and half) allows anyone to become a resident as long as you have guaranteed income of around $2000 a month or you deposit $60K into a local bank account and they arrange monthly disbursements and you pay 15% of your stated income to CAJA. Healthcare is both better and more affordable here. The same is true for Panama. Why can’t the US figure this out?
- GenerWork 6mo ago
  >If you lost your job, before the ACA, you could not get health insurance outside of working for someone and having group insurance at any cost. This is a flat out lie. You absolutely could buy health insurance without being at a company.
  - raw_anon_1111 6mo ago
    Not if you had a pre-existing condition - the entire point of this thread.
- LorenPechtel 6mo ago
  And if you had an expensive dependent better work for a big company. Saw it happen--wife lost her coverage through work because they had an employee with an expensive kid. Next year insurance wasn't offered.

antisthenes 6mo ago

> people have forgotten how bad things used to be Not really, because whereas before things were bad for people with pre-existing conditions, now they are really bad for everyone. People are paying exorbitant prices either for insurance, for routine health care stuff, or for both. There was no free lunch, so we traded some health care for the chronically ill, for slightly less healthcare for everyone else. The insurance companies make sure it's an extractive zero-sum game in terms of actual healthcare provided.

raw_anon_1111 6mo ago
When I was looking for healthcare after my employer went tits up right before the ACA went into affect, I couldn’t buy insurance at any price because of a pre-existing condition. Mine you that I have had my ore-existing condition since birth in 1974, had one surgery my entire life - foot surgery in 1996 - and this was 2011 and now I’m 52 and still haven’t had any complications from it and don’t expect to. I was also a part time fitness instructor, runner and could past any of the standardized fitness assessment standards for someone who was 5 years younger as far as push ups, sit ups, running etc. I had a contract so I could have easily paid more based on risk. Before anyone mentions COBRA, that’s only an option if your former group plan still exists and it didn’t when the company went out of business. Just looking, even now the ACA Silver for my wife and I would be around $800 a month in my state. Even ignoring medical costs have gone up more than inflation, that would have been $550 a month in 2011 if the ACA had been available.