# $400 million bribe if the GOP repeals the Affordable Care Act? It can't be true, right... **URL:** \ **Category:** Great Debates\ **Created:** [September 22, 2017, 3:14am UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934 "2017-09-22T03:14:32Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [September 24, 2017, 9:48am UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/101 "2017-09-24T09:48:07Z")
> [@SamuelA](#): > > Any foreign trained doctor ought to be able to just show up and open up shop. They should be able to open clinics anywhere, without needing approval. Any pharmaceutical drug made by a licensed company anywhere should be imported. You had this before, Travellin’ Doctors would go from place to place either with their own entertainment entourage, or at the next carnival, and dispense good curing. ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [September 24, 2017, 2:37pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/102 "2017-09-24T14:37:31Z")
> [@iiandyiiii](#): > > In a different universe in which everything was the same except your circumstances were different such that you believed the ACA actually improved your family’s specific circumstances, would you support the law? I don’t know. Aside from being bad for me and my family, the current iteration offends some of my principles (individual liberty, limited government, free markets, etc.). If it were good for my family but still offended my principles, my degree of support or opposition would probably hinge on how much it improved my family’s specific circumstances. I suspect that answer will invite some snarky remarks about ‘just haggling over the price’, but I fully admit that my politics result from a messy interaction of principles and self-interest. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [September 24, 2017, 3:19pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/103 "2017-09-24T15:19:12Z")
> [@SamuelA](#): > > You know, I did think of a way to make the “pay your own way” feasible. This is a very libertarian philosophy. The trouble is, all pharmaceutical drugs are only available from government approved companies within the borders of the USA, and the government puts onerous barriers in the way of approval of even generics. > > … Without commenting on the specifics of this plan, by your own admission there exist other ways to achieve these end goals that don’t involve retaining the ACA. Which is my point. ---
**Author:** ![SamuelA](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@SamuelA](https://boards.straightdope.com/u/SamuelA)\ **Post date:** [September 24, 2017, 3:24pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/104 "2017-09-24T15:24:14Z")
> [@Bricker](#): > > Without commenting on the specifics of this plan, by your own admission there exist other ways to achieve these end goals that don’t involve retaining the ACA. > > Which is my point. Umm, that was implied. Everyone here in this debate I thought knew this. Everyone knows the ACA is a conservative solution to this problem. People are required to pay their own way - that’s what the individual mandate is. The only reason there’s tax credits is that it’s so stupidly expensive than a significant number of people physically can’t, it is not possible, so that’s what they arrived at. Everyone with any knowledge of the system knows that the ACA is a 3-legged stool, you cannot change any major provision without setting it up for eventual collapse. There must be an individual mandate, there must be tax credits, there must be no pre-existing conditions, it must cover most scientifically accepted effective treatments, and you can’t really pick and choose on these things. You can make it better, but since the ACA is about the most conservative plan that can possibly be still functional by the laws of mathematics (without flipping it around like I said and doing something extreme), none of the conservative plans are going to result in something better. They all result in a worse mess than we have. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [September 24, 2017, 3:24pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/105 "2017-09-24T15:24:19Z")
> [@SamuelA](#): > > Ok. Here’s my position. > > Humans like being alive. A lot. Almost infinitely much. > > So let’s see if we can find things we agree on. There is a certain probability you will be alive in 5 years. (picking a 5 year window since some diseases take several years to kill you). All things held equal, if you have access to 50% of available medical treatments, versus 90% of available medical treatments, do you agree that the probability of you being alive in 5 years is higher? > > So the total Expected value = (value of being alive) \* (Probability of being alive). > > Why did I imply the ACA increases access to medical treatments if you personally have the best corporate health insurance? The reason is that there is a non-zero chance you will be fired, wrongfully even if you are the company’s best performer, and lose access to that. That puts you on the individual market, where pre ACA plans only give you access to a small subset of available treatments, practiced policies of dropping people who make claims, and exclude treatments for any pre-existing conditions. > > Oh, but you have $50,000+ saved up, and can keep making the $2000 a month COBRA payments until you get a new job. Well, good for you, but statistically you are rare and if you were the only ones voting against the ACA, it wouldn’t be in any danger of getting repealed. > > Where I think you have an argument is what if you don’t value your life very much. But you hugely value new rims for your truck. So you resent being made to pay for health insurance (individual mandate), and would rather have an additional 10-20% of your income so you can buy the new rims and chrome and all the rest for your hobbies. > > I would simply counter that since you do value things that give you enjoyment (the rims), and you get 0 value if dead, in fact you **do** value your life quite a lot, and you’re simply wrong when you claim you don’t. And if you then go for policies that shorten your life at the benefit of some small increase in marginal short term enjoyment, I’d say you’re acting stupidly, and from an objective sense, you are. > > Note that these assumptions are based on the fact that the individual mandate combined with the tax credits limits the amount you spend on insurance to a reasonably small fraction. Since money has a diminishing utility, having 80% of your available income versus 100% makes not much of a difference, you can get the things that you enjoy in life on a moderately lower budget pretty well. If buying insurance meant you had to eat bread and water and shiver in the cold for the rest of your life, while you could live like a king as an uninsured, that would be a different scenario. (since if living like a king = 10x more enjoyment from being alive, a shorter total life with more enjoyment is better) And perhaps I contend that a country with more emphasis on self-reliance will produce such greater overall good that I am willing to risk my own loss of life to foster that outcome, in the same way that people die for their country’s ideals in other ways. Can you disprove that decision’s value, using universal postulates? ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [September 24, 2017, 3:35pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/106 "2017-09-24T15:35:23Z")
> [@Bricker](#): > > I care about abstract entities. > > And now what? > [@Bricker](#): > > And perhaps I contend that a country with more emphasis on self-reliance will produce such greater overall good that I am willing to risk my own loss of life to foster that outcome, in the same way that people die for their country’s ideals in other ways. > > Can you disprove that decision’s value, using universal postulates? That’s noble of you, to be willing to sacrifice yourself for noble principles. Very noble indeed. But, wait, is it you that is being sacrificed to these noble principles? Is it you that is denied life saving healthcare? Are you the one in the position to suffer from the ACA being repealed? I think not. To sacrifice yourself for a principle is quite the noble act, but making someone else sacrifice himself for your principle is even more noble, amiright? ---
**Author:** ![SamuelA](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@SamuelA](https://boards.straightdope.com/u/SamuelA)\ **Post date:** [September 24, 2017, 3:46pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/107 "2017-09-24T15:46:00Z")
> [@Bricker](#): > > And perhaps I contend that a country with more emphasis on self-reliance will produce such greater overall good that I am willing to risk my own loss of life to foster that outcome, in the same way that people die for their country’s ideals in other ways. > > Can you disprove that decision’s value, using universal postulates? See the “being stupid” argument above. If you act irrationally in contravention to your own direct best interests that your behavior shows you follow (unless you are mentally ill), you’re just stupid or wrong. If you didn’t care about being alive a whole much, you’d probably already be dead and we would not be having this conversation. (I assume you’re a middle aged or older adult and have survived a great many things) And if you’re in a situation where the downsides of ACA repeal cannot apply to you (you are on medicare, have a large sum of money saved, etc), well, your vote wouldn’t be enough to matter regardless. Even if all of ‘you’ in that situation collectively voted the same way. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [September 24, 2017, 3:52pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/108 "2017-09-24T15:52:03Z")
> [@SamuelA](#): > > Ok. Here’s my position. > > Humans like being alive. A lot. Almost infinitely much. > > So let’s see if we can find things we agree on. There is a certain probability you will be alive in 5 years. (picking a 5 year window since some diseases take several years to kill you). All things held equal, if you have access to 50% of available medical treatments, versus 90% of available medical treatments, do you agree that the probability of you being alive in 5 years is higher? > > So the total Expected value = (value of being alive) \* (Probability of being alive). Am I to take it that this is laying out the steps of your proof? It’s pretty poor. I think you miss the fundamental nature of tradeoffs. As an example, consider speed limits. In most places, the speed limit on highways is between 55 mph and 70 mph. Certainly excessive speed contributes to car accidents, and if the speed limit were reduced incidents of accidents would also be reduced. If we set the speed limit to 10 mph in all places that currently exceed that limit, I think the incidents of fatal road accidents would be greatly reduced. In your construction, this would prove that reducing the speed limit to 10 mph is the way to go. Do you understand why we do not have a 10 mph speed limit? ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [September 24, 2017, 4:28pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/109 "2017-09-24T16:28:48Z")
> [@Bone](#): > > Am I to take it that this is laying out the steps of your proof? It’s pretty poor. I think you miss the fundamental nature of tradeoffs. > > As an example, consider speed limits. In most places, the speed limit on highways is between 55 mph and 70 mph. Certainly excessive speed contributes to car accidents, and if the speed limit were reduced incidents of accidents would also be reduced. If we set the speed limit to 10 mph in all places that currently exceed that limit, I think the incidents of fatal road accidents would be greatly reduced. In your construction, this would prove that reducing the speed limit to 10 mph is the way to go. > > Do you understand why we do not have a 10 mph speed limit? We do evaluate speed limits, and determine whether or not they are safe. We have 20 mph speed limits in school zones, we have 25 in residential zones. If you can show me a school zone with a 70 mph limit, I’ll be very surprised. We also make car manufacturers increase the safety of the cars, even though that adds to the cost of the cars. That speed limits and car manufactures are not responsible for completely eliminating all traffic accidents and deaths does not mean that speed limits and regulations on manufacturing cars is not responsible for reducing the number of traffic deaths very considerably. To use your car analogy, arguing against the ACA is like arguing against speed limits and seatbelt laws entirely. There are principles at stake, sure, but there are lives at stake on the other side of the argument. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [September 24, 2017, 5:07pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/110 "2017-09-24T17:07:39Z")
Wait! If I drive backwards at 100 mph, will Tinkerbelle live? _Reductio ad absurdum delenda est!_ ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [September 24, 2017, 5:17pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/111 "2017-09-24T17:17:09Z")
> [@k9bfriender](#): > > To use your car analogy, arguing against the ACA is like arguing against speed limits and seatbelt laws entirely. There are principles at stake, sure, but there are lives at stake on the other side of the argument. To be sure, in this thread I’m not arguing against the ACA. Yes I think it is a perversion of the role of government, but that’s not my point here. My point is, that SamuelA 's argument is bad. Terrible actually. It mischaracterizes opposition and misconstrues how to evaluate tradeoffs in decision making. What he takes as certainty is anything but. It’s a very poor argument. There are in fact, sound arguments in favor of the ACA. Just not from SamuelA in this thread. ---
**Author:** ![SamuelA](https://avatars.discourse-cdn.com/v4/letter/s/c77e96/32.png) [@SamuelA](https://boards.straightdope.com/u/SamuelA)\ **Post date:** [September 24, 2017, 5:27pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/112 "2017-09-24T17:27:17Z")
> [@Bone](#): > > T > There are in fact, sound arguments in favor of the ACA. Just not from SamuelA in this thread. Shrug. I tried. I think my arguments are sound and your reasoning is the fault, so we won’t get anywhere. Certainly, around the community I hang out (besides here), the basic concept is solid. I will comment that the reason the speed limit isn’t 10 mph is that the cumulative lifespan lost from traveling that slow exceeds the cumulative lifespan lost from car wrecks. That is, if people collectively lose 5 times as much of their lives as they do today waiting in cars, all those wasted hours total to a bigger number than the extra hours the people who die in crashes would have enjoyed. (since car crashes only kill about 1% of people) Of course, everyone where I hang out (reluctantly) accepts the reasonableness of cryonics. Cryonics is a poorly performed, crude method to preserve human brains shortly after death. It has a low probability of success. But, according to mainstream science, the probability is not zero, unless mainstream science is completely wrong about physical reality. So, if your lifetime earnings were 2 million dollars, and cryonics costs $100k, and the probability of being dead permanently without cryonics is 100% (mainstream science says it is), the math works out in favor of cryonics unless you assume it is so improbable to work that you can round to zero. This is because any society that can revive a frozen, damaged brain can keep that brain alive in some form for thousands of years, and thousands of years of life in some form is worth a huge amount. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [September 24, 2017, 5:32pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/113 "2017-09-24T17:32:39Z")
> [@Bone](#): > > …There are in fact, sound arguments in favor of the ACA. Just not from SamuelA in this thread. We wait with bated breath. Have you a couple of those excellent arguments close at hand? As you no doubt know, we lefties are a well-intended lot, but rather dull when it comes to crisp, hard-nosed rhetorical splendor. We could use your help, if you’ve nothing better to do. ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [September 24, 2017, 5:52pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/114 "2017-09-24T17:52:59Z")
> [@Bricker](#): > > And perhaps I contend that a country with more emphasis on self-reliance will produce such greater overall good that I am willing to risk my own loss of life to foster that outcome, in the same way that people die for their country’s ideals in other ways. > > Can you disprove that decision’s value, using universal postulates? But you aren’t risking your life. You have a high paying job with benefits. You’re going to be ok no matter what Congress does. For the tens of millions who don’t share your good fortune, they are the ones whose lives are being risked. Republicans are perfectly willing to throw them under the bus in order to give huge tax breaks to their donors, which is what Donaldcare 3.0 is all about. If Republicans cared about health care, they would have crafted a plan in the past 7 years. They didn’t. Let’s face it- they can’t govern, they can only oppose. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [September 24, 2017, 6:32pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/115 "2017-09-24T18:32:16Z")
> [@SamuelA](#): > > Shrug. I tried. I think my arguments are sound and your reasoning is the fault, so we won’t get anywhere. Certainly, around the community I hang out (besides here), the basic concept is solid. I will comment that the reason the speed limit isn’t 10 mph is that the cumulative lifespan lost from traveling that slow exceeds the cumulative lifespan lost from car wrecks. That is, if people collectively lose 5 times as much of their lives as they do today waiting in cars, all those wasted hours total to a bigger number than the extra hours the people who die in crashes would have enjoyed. (since car crashes only kill about 1% of people) > > Of course, everyone where I hang out (reluctantly) accepts the reasonableness of cryonics. > > Cryonics is a poorly performed, crude method to preserve human brains shortly after death. It has a low probability of success. But, according to mainstream science, the probability is not zero, unless mainstream science is completely wrong about physical reality. So, if your lifetime earnings were 2 million dollars, and cryonics costs $100k, and the probability of being dead permanently without cryonics is 100% (mainstream science says it is), the math works out in favor of cryonics unless you assume it is so improbable to work that you can round to zero. This is because any society that can revive a frozen, damaged brain can keep that brain alive in some form for thousands of years, and thousands of years of life in some form is worth a huge amount. That’s an interesting health care plan. Got terminal cancer? Freeze yourself. Got heart disease? Freeze yourself. Acne? Freeze yourself. One main objection to the cryonics argument is that you are assuming that a society thousands of years in the future would have any need for you. There may be a few corpsicles revived for historical reasons, but the vast majority will either sit in vaults forever, or have accidents and become less than viable, or have “accidents” and become less than viable. Just as our society seems to put very little value on preserving the lives of the people who are here right now, I don’t see why a future society would place any more value on the lives of people who have already lived their lives in the past. Sure, last ditch effort, and if you can afford it, why not? But it is not a very good actual plan for people who want real solutions to real problems. ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [September 24, 2017, 7:05pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/116 "2017-09-24T19:05:08Z")
> [@BobLibDem](#): > > … Let’s face it- they can’t govern, they can only oppose. It may not surprise you that I’m rather comfortable with having a party that can’t get any legislation passed in charge back in Washington. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [September 24, 2017, 7:06pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/117 "2017-09-24T19:06:00Z")
> [@HurricaneDitka](#): > > I don’t know. Aside from being bad for me and my family, the current iteration offends some of my principles (individual liberty, limited government, free markets, etc.). If it were good for my family but still offended my principles, my degree of support or opposition would probably hinge on how much it improved my family’s specific circumstances. > > I suspect that answer will invite some snarky remarks about ‘just haggling over the price’, but I fully admit that my politics result from a messy interaction of principles and self-interest. Well, in the real American world (and specially before ACA) _individual freedoms were restrained_, as mentioned before it has been a wonder of deception that the republicans and [del]stink[/del] think thanks convinced many of the opposite. I posted this **before** ACA was deployed: **We have less freedom (in 2009) in the US now.** Many Americans do not have freedom from the fear… of going bankrupt for health reasons. Latest reports show that even families that thought that they had coverage found that bankruptcy was their only option after the insurers dropped them. > **[Insurers Denied Health Coverage to 1 in 7 People, Citing Pre-Existing Conditions](https://www.propublica.org/article/insurers-denied-health-coverage-to-1-in-7-people-citing-pre-existing-condit)** > > ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest. > [@](#): > > The nation’s four largest for-profit health insurers denied coverage to more than 651,000 people over a three-year period, citing pre-existing conditions, according to an analysis of insurer data detailed in a Congressional investigation. > > Between Aetna, Humana, UnitedHealth Group, and WellPoint, that averages out to a denial of coverage for one out of every seven applicants, according to an Energy and Commerce Committee memo about the investigation. > > The memo, released by Energy and Commerce Chairman Henry Waxman and Bart Stupak, both Democrats, touts provisions in the health care reform bill that address pre-existing condition denials. **Many Americans do not have the freedom to seek a different job or to work on their own.** Job Lock is specially real to families that have one their members suffer a condition that will be considered preexisting if a job switch takes place. (Even with COBRA the reality is that many can not afford the COBRA payments and then they can not expect the same coverage if another job appears) And Workers that wish to start a business on their own find that heath care costs put a barrier to it. [http://www.reuters.com/article/us-usa-healthcare-jobs/u-s-health-system-discourages-innovation-idUSTRE54O4K120090526](http://www.reuters.com/article/us-usa-healthcare-jobs/u-s-health-system-discourages-innovation-idUSTRE54O4K120090526) > [@](#): > > WASHINGTON (Reuters) - Countless workers in the United States are trapped in jobs they would like to leave because they cannot get health insurance elsewhere, calcifying innovation and mobility in the world’s largest economy. > > “I would rather be freelancing, no question,” said Jessica Tolliver, a former editor who now works in public relations. “I got my work done in less time, because once I finished what I had to do, the time was my own.” > > Economists call this phenomenon “job lock,” and studies suggest that it keeps between 20 percent and 50 percent of workers from leaving their current jobs. > > Because health insurance is tied to employment in the United States, workers who leave their jobs can see health bills skyrocket if they strike out on their own or take a position with a company that offers fewer benefits. Workers who would like to retire early stay on, unable to qualify for the government’s Medicare program until they turn 65. > > And those who have existing health problems may not be able to get coverage at all. > > Job lock is difficult to measure because many employees don’t like to advertise their unhappiness. But economists and small-business advocates say it takes an enormous toll on productivity. > > SLOWING INNOVATION > > “We can definitely say that it’s slowing down the rate of innovation,” said Tim Kane, an economist with the Kauffman Foundation which promoted entrepreneurship. **Many Americans (and foreign companies) have less freedom to start a company in the USA thanks to the health care cost.** The high cost of health care is already a reason why the USA is not competitive with other nations. > **[Healthcare Costs and U.S. Competitiveness](https://www.cfr.org/backgrounder/healthcare-costs-and-us-competitiveness)** > > Some analysts say healthcare costs hinder U.S. industry competitiveness in the global marketplace, but it’s unclear whether proposed health reforms will offer any cost relief. > [@](#): > > Competitive Disadvantage > > The United States spent 16 percent of its GDP in 2007 on health care, higher than any other developed nation. The nonpartisan Congressional Budget Office (CBO) estimates that number will rise to 25 percent by 2025 without changes to federal law (PDF). Employer-funded coverage is the structural mainstay of the U.S. health insurance system. According the U.S. Bureau of Labor Statistics, about 71 percent of private employees in the United States had access to employer-sponsored health plans in 2006. A November 2008 Kaiser Foundation report notes that access to employer-sponsored health insurance has been on the decline (PDF) among low-income workers, and health premiums for workers have risen 114 percent in the last decade. Small businesses are less likely than large employers to be able to provide health insurance as a benefit. At 12 percent, health care is the most expensive benefit paid by U.S. employers, according to the U.S. Chamber of Commerce. > > These ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace. For large multinational corporations, footing healthcare costs presents an enormous expense. General Motors, for instance, covers more than 1.1 million employees and former employees, and the company says it spent roughly $5.6 billion on healthcare expenses in 2006. GM says healthcare costs add between $1,500 and $2,000 to the sticker price of every automobile it makes. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival, Chrysler. > > It is difficult to quantify the precise effect high healthcare costs have had so far on the overall U.S. job market. Health care is one of several factors–entrenched union contracts are another–that make doing business in the United States expensive, and it’s difficult to parse the effects of each factor. Moreover, economists disagree on the number of U.S. jobs that have been lost to offshoring–the transfer of business operations across national boundaries to friendlier operating environments. The Princeton economist Alan S. Blinder, in a 2006 Foreign Affairs article, says that judging by data compiled from “fragmentary studies,” it is apparent that “under a million service-sector jobs in the United States have been lost to offshoring to date.” Blinder goes on to predict that somewhere between 28 million and 42 million U.S. jobs are “susceptible” to offshoring in a future where technology allows the more efficient transfer of jobs. Many other economists, however, have shied away from making such estimates, and some have criticized Blinder’s approach. > > It is clear, however, that healthcare expenses affect every level of U.S. industry. For large corporations they mean the massive “legacy costs” associated with insuring retired employees. For small business owners they can be even more devastating. “In many places, you have small businesses that simply cannot afford to offer coverage,” Sarbanes says. Often, he says, healthcare expenses make it impossible for small business owners to hire candidates they would otherwise desire. Again, all that was pre ACA and besides being a reply to **HurricaneDitka** it also deals a lot with the crummy points from **Bricker** ; he and others are really clueless about how, besides they really defending the “right” for Americans to have **less freedom** or life, Republicans in power specially do not notice the waste in money and opportunity their position has. Not to mention the implied notion that Republicans in power would indeed rather had me see dead and many others just to make reality their point of view. What kind of freedom is that? ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [September 24, 2017, 7:07pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/118 "2017-09-24T19:07:54Z")
> [@HurricaneDitka](#): > > It may not surprise you that I’m rather comfortable with having a party that can’t get any legislation passed in charge back in Washington. Surprisingly, I’m in agreement. Especially as one of the main legislative goals is the repeal of the ACA. Having a party that cannot even agree on what they all campaigned on for 7 years is disturbing, and I would find it embarrassing if it were the party that I supported, but in this case, it turns out to be a good thing. ---
**Author:** ![HurricaneDitka](https://avatars.discourse-cdn.com/v4/letter/h/96bed5/32.png) [@HurricaneDitka](https://boards.straightdope.com/u/HurricaneDitka)\ **Post date:** [September 24, 2017, 7:15pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/119 "2017-09-24T19:15:40Z")
> [@GIGObuster](#): > > Well, in the real American world (and specially before ACA) _individual freedoms were restrained_, as mentioned before it has been a wonder of deception that the republicans and [del]stink[/del] think thanks convinced many of the opposite. > > I posted this **before** ACA was deployed: > > **We have less freedom (in 2009) in the US now.** > > Many Americans do not have freedom from the fear… of going bankrupt for health reasons. > > Latest reports show that even families that thought that they had coverage found that bankruptcy was their only option after the insurers dropped them. > > [Insurers Denied Health Coverage to 1 in 7 People, Citing Pre-Existing Conditions — ProPublica](https://www.propublica.org/article/insurers-denied-health-coverage-to-1-in-7-people-citing-pre-existing-condit) > **Many Americans do not have the freedom to seek a different job or to work on their own.** > > Job Lock is specially real to families that have one their members suffer a condition that will be considered preexisting if a job switch takes place. (Even with COBRA the reality is that many can not afford the COBRA payments and then they can not expect the same coverage if another job appears) And Workers that wish to start a business on their own find that heath care costs put a barrier to it. > > [http://www.reuters.com/article/us-usa-healthcare-jobs/u-s-health-system-discourages-innovation-idUSTRE54O4K120090526](http://www.reuters.com/article/us-usa-healthcare-jobs/u-s-health-system-discourages-innovation-idUSTRE54O4K120090526) > **Many Americans (and foreign companies) have less freedom to start a company in the USA thanks to the health care cost.** > > The high cost of health care is already a reason why the USA is not competitive with other nations. > > [Healthcare Costs and U.S. Competitiveness | Council on Foreign Relations](https://www.cfr.org/backgrounder/healthcare-costs-and-us-competitiveness) > > Again, all that was pre ACA and besides being a reply to **HurricaneDitka** it also deals a lot with the crummy points from **Bricker** ; he and others are really clueless about how, besides they really defending the “right” for Americans to have **less freedom** or life, Republicans in power specially do not notice the waste in money and opportunity their position has. Not to mention the implied notion that Republicans in power would indeed rather had me see dead and many others just to make reality their point of view. > > What kind of freedom is that? Is it your position that the ACA resolved these issues? That there are no longer “many Americans” with “fear… of going bankrupt for health reasons” or that “many Americans” now, thanks to the ACA, have “freedom to seek a different job or to work on their own” that did not pre-ACA? ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [September 24, 2017, 7:43pm UTC](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934/120 "2017-09-24T19:43:32Z")
> [@HurricaneDitka](#): > > Is it your position that the ACA resolved these issues? That there are no longer “many Americans” with “fear… of going bankrupt for health reasons” or that “many Americans” now, thanks to the ACA, have “freedom to seek a different job or to work on their own” that did not pre-ACA? By a good deal, yes. You seem to skip the posts from **k9bfriender** showing how he and his new workers can start a business when before ACA almost no employee would had looked to get a job under him if the then extremely costly insurance was the only thing available. He is not the only to notice: [http://www.modernhealthcare.com/article/20161228/NEWS/161229966](http://www.modernhealthcare.com/article/20161228/NEWS/161229966) > [@](#): > > He and other young entrepreneurs don’t like that the GOP repeal-and-delay strategy will leave them hanging in insurance limbo for several years. “If it’s repealed, I might have to go back to working for a bigger employer,” he said. “The prospect of losing my business because I’m losing my insurance is sort of ridiculous to me.” > > But Republican experts say people in Lapp’s position have no reason to fear because Trump and Congress will keep the ACA provisions in place for two to three years and then put in place a solid replacement system. GOP replacement proposals, such as House Speaker Paul Ryan’s Better Way white paper, still lack many key details, however. Of course as the CBO and others pointed out, that what Ryan said was and remains poppycock. As others pointed, not all the cases of Job Lock are gone, as even I pointed before even when it is getting better there is more work to be done. > **[Op-Ed: Will Obamacare end 'job lock'?](https://www.latimes.com/opinion/op-ed/la-oe-0411-baker-obamacare-job-lock-20160411-story.html)** > > The Affordable Care Act was first and foremost intended to extend health insurance coverage to a broader segment of the population. > [@](#): > > We are still in the early stages of ACA implementation, and the labor market remains weak from the Great Recession, **but there is evidence that the health insurance reform law is mitigating job lock and giving workers more freedom**. This is most apparent in the substantial rise in voluntary part-time employment. In the first three months of 2016, the number of people voluntarily working part time was up by more than 1.7 million (10%) from the first quarter of 2013, the last year before the exchanges were in place. > > To be clear, these are people who say that they are working part time because they want to work part time. There are still a large number of people who work part time because they can’t get full-time jobs, but this number is down by 1.9 million (24%) from the pre-ACA level. > > In other words, the number of people who are stuck working part time has been dropping rapidly since the ACA came into effect, while the number who choose to work part time has risen substantially. > > The Center for Economic and Policy Research analyzed the rise in part-time employment in the first year after the ACA took effect and found that the increase was largest among young parents. This suggests that many parents are choosing to spend more time with their kids now that they have the option to buy healthcare insurance on the exchanges. > > There is also evidence of an increase in the number of people choosing to start their own business. The number of people who are self-employed at incorporated businesses is up by 7.8% from the first quarter of 2013. It’s too early to know if this increase will be sustained (these data are erratic), and it may just be attributable to a strengthening labor market. Alternatively, the rise in self-employment could mean that access to insurance on the exchanges has allowed more workers to feel secure enough in their financial situation to scratch an entrepreneurial itch. Those working part time, while looking for a better job environment, also include guys like me. I’m currently working to get a science teaching certificate and during the dark days of the recession I stayed afloat with part time work at local schools mostly in IT and substitute teaching. That was the time when the ACA did save my life BTW. So, once again, you really need to stop defending Republicans that in reality do see slavery\* as freedom. - Or to be more precise, as I also said during the discussions about the ACA, you are defending a system that only a feudal lord would be proud to have. [Previous page](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934.md?page=5) [Next page](https://boards.straightdope.com/t/400-million-bribe-if-the-gop-repeals-the-affordable-care-act-it-cant-be-true-right/796934.md?page=7)