Repealing the ACA with new healthcare reform

All right, let’s suppose the following bill is proposed, and you can only vote Yes or No, you cannot make any amendments:

  1. Repeal the ACA in its entirety.
  2. Institute single-payer health care.
  3. Force all hospitals and health-care providers to publish prices for all procedures and not deviate from them.
  4. Permit health-insurance companies to discriminate on the basis of pre-existing conditions (it’s not fair if someone uninsured suffers a broken arm, purchases insurance, and *then *wants the insurance company to pay for the preexisting broken arm.)
  5. Institute stiff penalties for patients who can afford to pay their bills but deliberately refuse to.
  6. Have a deductible for health care so that there is a deterrent to misuse of the health care system (i.e., $10 for doctor visits, several hundred dollars for surgery, which is still miles cheaper than the current health care system,)
  7. Institute stiff criminal penalties for people who commit Medicare fraud (there has been tens of billions of dollars in Medicare fraud in recent years; )
  8. Give the taxpayers a tax cut to help offset the burden of the single-payer health care premiums that they will be paying.
  9. Have end-of-life decision panels (yes, “death panels.”)
  10. Allow health-insurance companies to compete across state lines.
  11. Institute cap limits on medical-malpractice lawsuit compensation (getting millions of dollars for a broken finger is unreasonable)
  12. Since the ACA is repealed, individuals would no longer be required to acquire health insurance.
  13. Require abortion clinics to meet ambulatory center standards.
  14. People who can demonstrate financial need (i.e., being unemployed, broke, etc.) will be able to have their bills temporarily postponed - be it for a year, several years, or more - until they are demonstrably financially able to pay them.

I like 2 and 9

4, 11, and 13 are deal breakers. So, no way

Aren’t #2 and #4 mutually contradictory?

How can you have single payer and still have health insurance companies?

The insurance companies would simply have a lot less work.

Instead of paying for $50,000 surgeries, they’d be paying for $700 or $1,800 surgeries. Which, to many American household budgets, is still an expensive surgery.


Yeah, the plan in the OP makes no sense to me. The concept of single payer is that a single source (the government) pays the health care bills.

Not sure what you are trying to accomplish. The fact that it took 80 years to get Healthcare Reform passed, in the form of a committee-designed complexity-fest, is the ONLY thing that matters. You can design something 'till you’re blue in the face - show me how any changes can move through Congress. Until then, the design looks nifty on a cocktail napkin.

At this point, it appears that the ACA will move forward, and continue to evolve, just like the other programs like Social Security and Medicare have evolved over the decades.

This. The ban on pre-existinting-condition exclusions is one of the best things about the ACA. Denying people health care coverage because they need it is barbaric.

They can get coverage but should not expect a health insurance company to pay for *that *specific preexisting injury.

Analogy: If I am an uninsured driver, and then get in a car wreck, and *then *buy car insurance, it’s not fair for the insurance company to have to pay for that car wreck.

Not strictly true. I live in Denmark (which has one of the most expansive single-payer systems in existence, including a deductible for almost all healthcare procedures of literally nothing), and healthcare insurance absolutely is a thing that exists here, as are private hospitals.

The thing that people tend to forget to mention about single-payer healthcare is that it comes with long waits for procedures not considered medical emergencies - i.e if your local orthopaedic division is busy, you may have to wait 6 months to have your knee operated on, there may be a month’s wait to get an MRI done, etc.

In these systems, healthcare insurance and private hospitals exist as an additional, elective service, much in the way plastic surgery is elective. You are guaranteed that the public system will eventually get around to operating on your knee, sure - but if you have the funds and you find the 6-month wait prohibitive, you may have your surgery at a private hospital instead - and the public system will still, IIRC, allow you to deduct an amount equal to what you would have cost the public system from your private bill.

However, seeing as health insurance is neither mandatory nor ubiquitous, insurance companies may refuse to cover preexisting conditions with the law on their side. I, for example, can neither get coverage for my knee nor shoulder issues, which occurred while I was legally a minor and thus ineligible to purchase insurance. Effectively, in a single-payer system of the Scandinavian model, insurance and insurance “contracts” companies are in no way involved in the healthcare process unless the private citizen actively chooses to involve them.

Which is wrong. You never had the chance to choose to buy or not.

So require everyone to participate. You’re handing out tax cuts.

I am not denied coverage by the public system. I am guaranteed to get medical treatment for my shoulder issues at some point on equal footing with everyone else that has not chosen to purchase private health insurance, which is the vast majority of the population. Private health insurance is simply not a consideration for the vast majority of the population because the overall standard of care is incredibly high - those who choose to purchase private health insurance are generally professional athletes or so wealthy that the premium is a drop in a planet-sized bucket.

Insurance companies are simply not compelled to sell me insurance that is financially untenable for them in the first place, and I can still get private health insurance for literally everything that does not pertain to my shoulder or my knee. The only result of compelling them to do so under the Danish model would be increased insurance premiums and healthcare costs for everyone.

I should add that while I can certainly understand the view that it is immoral to allow insurance companies to discriminate in the case of preexisting conditions which originated before the age of legal majority, I consider it a strictly necessary evil for the system to function. When healthcare as provided by private hospitals and insurance companies is no longer a public good, I am of the opinion that it must be allowed to function with as few regulations as possible, and that includes allowing insurance companies to discriminate on the basis of just about whatever tickles their fancy. It is a strictly elective service, and as such providing it ought also be strictly voluntary.

I’m not going to support a health care reform plan that is just a bunch of buzzwords thrown together. This “reform” is basically incoherent.

Anything that starts with “first, repeal the ACA in its entirety” is the equivalent of Steve Martin saying “I can teach you how to get $1 MILLION DOLLARS TAX FREE!!! First: get a million dollars. THEN…”

Repealing the ACA isn’t going to happen, so now what?

I skimmed this far and almost voted Yes without further ado. OP had to be on the right track…

Instead I continue to skim quickly, immediately voted No in horror and am left with the question:

Velocity, what does “single-payer health care” mean to you?

I also don’t think he is making an appropriate distinction between a self-limited preexisting condition like a broken arm and a life long chronic condition like diabetes.

That is what single payer does. Nobody can opt out of paying 2.9% of income in medicare taxes, so if you break your arm on medicare you have already paid into the system.