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The affordable care act doubled most people's insurance over night (This happened to me and almost everyone I know). Nobody wants to mention this, because it makes their side look bad.

Until we can admit where there are problems, there will never be a solution.

That doesn’t pass the sniff test. I was self-employed and self-insured when the ACA took effect and my premiums immediately dropped when I purchased through the Marketplace (and it wasn’t subsidized).

It sounds like you either had junk insurance or you’re exaggerating things to score points.

I find it VERY likely they had a junk policy. This is one of the most important things the ACA did, it defined what could be considered health insurance. Before the ACA, a company could sell you a policy that essentially covered nothing. Usually those junk policies had cleverly worded agreements that hid the fact that nothing was covered (pre-existing conditions, restrictive networks, carve-outs for expensive treatments, etc).

Since the majority of people don't run into those issues, they are blissfully unaware that if/when they have a major medical event they are under-insured.

When the ACA plans first came online in South Carolina, I switched over immediately. I was paying something like $300 per month as a young healthy single male with my small company plan. I got a Marketplace plan for about $120 per month. The next year my insurer went out of business but I found another insurer in the 200s, barely cheaper. The following year this insurer also went under. I was now left with Blue Cross as my only real option charging I believe $350 per month and this continued to rise year on year, very painful for me when I was launching a startup with a minimal salary draw. Maybe your state is different but for me it killed numerous companies and left me with expensive, low quality options.
Yes, health insurance costs rise every year. Partly due to increasing costs, but also due to the age of the insured.

The question isn’t whether the ACA raised costs—those were always going to go up. The question is whether a the ACA made them go up less than not having it. For me, the before and after trend was remarkable. And I had higher quality insurance without lifetime maximums or arbitrary exclusions.

Republicans did their level best to neuter the bill and prevent Democrats from having a “win,” and for the most part, I’d say they succeeded. The lack of a public option and the removal of mandatory coverage were both important parts of making it work well. But in the first 5 years or so, it was definitely an improvement. I think it could be again… if Republicans cared more about serving the country than pandering to their base.

Over the course of my life I have seen every profession but one go through boom and bust cycles.

I've seen attorneys, professors traders, plumbers, programmers, accounting, all go through demand cycles.

But never MDs

It is my dream that before I die I see a bust cycle on MDs where the growth of supply exceeds the demand.

Uber or Airbnb for medical care is so needed, why not break some laws to reveal how protectionist the whole industry is?

I'd gladly book a "Parody Doctor" or whatever it takes if it cost 2/5ths the price.

> those were always going to go up

No. That wasn't the promise. Obama said that his plan was going to cut a family's bills by $2500.

Now you may say that inflation has to creep in and I think that's fair. If oil rises in price, that affects everything. But the premise was always that the magic of the ACA would lower premiums.

I recall the "magic" of the aca actually being focused on junk insurance so bad they look like scams, a marketplace to facilitate apples-to-apples competition, and most importantly, making it illegal to deny coverage to people because of genetic tests or public/stolen information like that (a great thing to see the 23&me breach coming).

My impression was it would be painful in a lot of ways but we need better competition and better protection in order to have the private insurance industry actually work for people instead of abuse them and health insurance is too important (and complicated, and too much history of dishonesty) for laissez faire.

Passes the test of my freelancer friends. They said at lunch that the long term change has been dramatic. What cost $300/m before the ACA turned to $3000/m today. These are all through the local Blue Cross. We talked about the junk policy idea. Certainly the post-ACA policies have some improvements like no pre-existing conditions, but it's pretty much a tangerine-to-oranges comparison.

Maybe yours dropped immediately, but I'm sure it's up quite a bit since then. You may say that's just inflation and that's part of it, but I think the deeper point is that the ACA is not containing the inflation. And that was one of the promises.

The fundamental problem is the very idea of private "health insurance".

Market forces naturally create low rates for those who don't need insurance and unaffordable rates for those who do. But over time, everyone gravitates from the former to the latter.

The "free market" does not offer a practical solution to every problem. Tariffs are an open admission of this basic fact.

The problem rather is the insane amount of red tape involved if you want to set up your own health insurance company. Thus hardly any competition for the established player arises.

The result is what any arbitrary textbook about economy will tell you: if there are large barriers to entry into a market (i.e. the opposite of "free market"), the customer won't get the positive consequences of a free market, but instead oligopolies will form - with their negative consequences.

There are lots of health insurance companies operating in the USA. United Health is the largest but they only have a 15% market share.

All these companies follow suit with the market forces described above. They all want to insure young healthy people and deny old sick people --- simply because they make more money by doing so.

Over time, everyone (including you) will naturally gravitate from young and healthy to old and sick --- aka uninsurable.

Are you content for yourself or your family to be uninsured when they need it most --- after a lifetime of paying premiums? This is what private, for-profit health insurance manifests.

This is not due to "red tape" or lack of competition but is a fundamental and unavoidable characteristic of the "free market" itself.

> All these companies follow suit with the market forces described above. They all want to insure young healthy people and deny old sick people --- simply because they make more money by doing so.

A private health insurance company is based on the idea that if you are young, you pay a lot more so that an actuarial reserve is built, which is then reduced again when you age. This means that if you want fair premiums when you are old, you will have to pay a lot larger premium in the young age.

Concerning your claim:

"They all want to insure young healthy people and deny old sick people --- simply because they make more money by doing so."

Insurance companies don't make more money when they insure young vs old people - but they will just calculate risk-appropriate premiums for each group. If you start your insurance coverage at a health insurance company when you are already old, no actuarial reserve has been built up (during the years when you were young), so the premiums will of course be much larger.

no actuarial reserve has been built up

This is laughable.

Health insurance companies don't have no steenkin "actuarial reserve". Inventing one is an act of rhetorical desperation on your part.

They only thing these companies consider or respond to is next quarter's profits.

> Health insurance companies don't have no steenkin "actuarial reserve". Inventing one is an act of rhetorical desperation on your part.

This is how private health insurance companies work in Germany and many other countries (more precisely for Germany "private Krankenversicherung nach Art der Lebensversicherung" (Google Translate: private health insurance in the form of life insurance); formally, in Germany there also exists "private Krankenversicherung nach Art der Schadenversicherung" (Google Translate: private health insurance according to the type of indemnity insurance)).

Facts:

- I have already worked with certified actuaries, and I am thus very certain that building an actuarial reserve which is then phased out when you get older [in German: Auf- und Abbau der Deckungsrückstellung (for life insurance) und Altersrückstellung (for health insurance) (in English, the term "actuarial reserve" is used for both kinds of reserves)]) is how the mathematics of life and private health insurance companies works (OK, formally only for the kind of health insurance that in German is called "private Krankenversicherung nach Art der Lebensversicherung" (Google Translate: private health insurance in the form of life insurance))

- if you still don't believe my claims, just read a good textbook about insurance of persons

There's around a thousand organizations in the US that have gone through the paperwork to set up as a health insurance company and continue to file paperwork to that effect.
I gained insurance overnight because of the ACA after not being able to afford it.
As a non-american this is the first I'm hearing of this. I would've thought if the majority of americans' health insurance had double overnight then there would've been massive uproar.

Can you explain what's happened?

The health insurance companies were given massive government subsidies to insure the previously (theoretically) uninsurable with no real provisions to cap rate hikes for anybody, and no alternative plan (public alternative that was originally part of the bill was killed). Large corporations received a captive market where people HAD to purchase health insurance (or pay a relatively onerous-at-the-time fine).

Insurance companies wrote for, edited, and lobbied around most of the bill as it was passed.

E: A fun downstream effect of it was that employer-provided insurance rates also went through the roof.

I wonder if this is a regional issue; didn't do anything of the sort for me and people I know in Massachusetts, but there the Affordable Care Act wasn't that different than the existing "Romneycare" state regulation. In cases where state regulation was much lesser I guess it likely had a bigger impact.
He's exaggerating. It wasn't literally overnight but over several years.
The ACA was intended to reduce the rate of rate increases, not reduce the cost overall. The proper comparison is to what the rates would have been without the ACA.

As usual, actual studies are all over the map on this. The white house said it was successful at that. NBER said it wasn't, but rates didn't double for a long time. We know rates of large increases went down for a few years, but small increases became nearly universal to compensate.

The two times I did not have employer sponsored health care AND $0 income, the ACA plans were more expensive than getting a plan directly from the insurance company. It never costed me $27,000 though.

Most recently, in 2024, I had medical and dental coverage for my family of 6 for around $1,200/mo - roughly half what's quoted but again, family of 6. Wasn't the greatest insurance but it would have kept us from financial ruin in case of a catastrophic event which is all I expect from insurance anyways.

I assume you were young. Direct was generally cheaper for young people and ACA cheaper for older people. Which pushed the average age of ACA up and then raises the price of ACA. It’s a mess!
45 years young.
I can only speak for myself and not "most people" but before the ACA I was actually denied for health insurance - as in, insurers would not sell me insurance at ANY price.

After ACA went into effect, I got insurance and it was reasonable - I didn't even need to claim a subsidy for first few years, until I lost my job.

Did not change my rates a bit. And it gave me a fallback plan if I lost my job or something.
Nearly tripled in my case, but I've literally been either told that that was a conspiracy theory (still flabbergasted as to how?), or been argued against with some vague appeal-to-emotions with regards to "but the poor people without health coverage". I wasn't exactly just out of minimum wage territory living paycheck to paycheck as a junior sysadmin at the time either, but who's counting, right?
ok its appeal to emotion but why is it vague?
Because at the time I could name about 20 people who lived at or below minimum wage with or without healthcare insurance and the ones that would conduct this appeal could not.
Bikeshedding about the style of the hair of the person involuntarily buggering you.

Proper healthcare is needed, because this one is unfair and too expensive compared to everywhere else with worse outcomes.

Proper healthcare is me going to the doctor and paying them an hourly rate to diagnose/work on me, please do not conflate it with health insurance.

(Here's a hint, it's actually quite affordable right now if you go to a GP out of pocket).

> (Here's a hint, it's actually quite affordable right now if you go to a GP out of pocket).

You're wrong and you're conflating your myopic perspective with the experiences of everyone else in the world in other countries. It's only "cheap" where you live. Here where I live, it's insanely expensive with (very expensive) insurance or without insurance (bankruptcy risk) and the average care is shit too.

Our country can afford it because it’s the last reliable source of privatized growth in revenue growth per year left in our economy. (A.I., by comparison, has merely a one-time effect of reducing headcount per dollar earned, and the Internet stripped away 99% of consumer-originated postal mail so there’s no growth left from privatizing that anymore.) So from a political standpoint it’s either maintain the health insurance nightmare or preside over the collapse of oligarchical capitalism.

That’s what this article fails to comprehend: the problem isn’t that health care is being done poorly, but that it’s the only source of GDP growth in the U.S. economy. All of the points it makes are fine points, but they’re irrelevant to the cause of the problem, so they will have little effect on the problem.

> last reliable source of privatized growth

But is it productive growth?

Perhaps we should increase GDP by employing people to smash windows and burn down houses?

Is that a growth strategy for the second derivative of profit? Asking for a friend :)
I'm in a EU country, in total I pay also around 15.000 EUR per year
In Germany a couple of two software developers would earn above the threshold of ca. 70k EUR per year each and therefore pay each around 15.000 EUR per year, which would be higher than the number given in the article ($27.000 for a family in US vs. around $35.000 in Germany currency converted). This applies for the public insurance where adults each have to be insured but kids are included for free.

People with lower incomes pay proportionately less, government employees and high earners can also switch to private insurance where they get much better service but for non-government employees this comes with risks and has to be done at a younger age.

You're comparing what appears to be the MAXIMUM cost of German health insurance with the AVERAGE cost of US health insurance.
I prefer to say, the MEAN cost, on this topic; it’s the same thing but more opinion-forward :)
Caught me!!!! I didnt read the article before sending my comment! :-)

OK, if its for a whole family, then yes: Germany is more expensive, I can see now - 27000 USD for a 4-head family is acutally quite cheep, if i add up those numbers?

[citation needed]
Not sure if I understand you correctly:

Do you mean some more numbers or the link to a healthcare-cost-calculator?

Either one. As someone who has lived in more than one EU Member State, I cannot fathom spending that amount for good care no matter my state of health.