Steph 🏳️‍🌈

@LargoLentoVento @N_Boyajian @atlas_jarreta @Karl_Was_Right You’re arguing pointless semantics are kinda dumb, sorry

@N_Boyajian @atlas_jarreta @Karl_Was_Right @Steph_lly But it didn't do that. It just allowed more customers to interact with a pre-existing system

Obama had the closest thing to a mandate of heaven a US president could and proceeded to pass no meaningful structural changes to US society beyond a giveaway to insurance companies while massively expanding Middle East bombings and turning one African country into a failed state

@LargoLentoVento @N_Boyajian @atlas_jarreta @Karl_Was_Right The only way it’s remotely similar to the “pre-existing system” is that it is still private insurance. American insurance today is very different in all other respects compared to 20 years ago

@LargoLentoVento @N_Boyajian @atlas_jarreta @Karl_Was_Right The ACA doesn’t benefit private insurance like you think it does and it’s really ignorant of you to claim that when you clearly don’t have any actually knowledge of the legislation in place.

@N_Boyajian @atlas_jarreta @Karl_Was_Right @Steph_lly No, he did not make substantial differences. He made minor changes that revolved around the alt-right plan that just ended up massively benefitting privatized insurance. Incrementalism isn't structural change. It's the antithesis of it.

@king_of_bob @Karl_Was_Right And how many more wouldn’t have coverage without it

@Steph_lly @Karl_Was_Right The ACA was written by the same people who wrote Project 2025. But please, tell us about how great the individual mandate is, or how millions of people still don't have coverage.

@caitoz This is an incredibly stupid take

Trump and Harris are 99% identical in terms of the real policies they'll promote. Trump and Harris supporters hate each other because of that 1% difference; I hate them both because of that other 99%.

@dbeatdadrocker @Karl_Was_Right It was widely unpopular among democrats too 🥲

@Steph_lly @Karl_Was_Right Obama campaigned on a public option, which would’ve been an actual change, and then gave up on it immediately

@Boon_doggl @Karl_Was_Right @miiryos I can accept that position. I’m in the same boat as you insurance wise, some states are a lot better than others unfortunately. The state exchanges were a stupid fucking compromise it should have stayed federal. Shrinking insurance markets is bad but republicans are ever so smart

@Steph_lly @Karl_Was_Right @miiryos I disagree on the idea that it was the best they could do, but regardless they DID do it. But what 'It' was wasn't something that altered the structure of healthcare in any fundamental ways. I use a state exchange to get my insurance but I still pay out the ass to a private comp.

@Karl_Was_Right @N_Boyajian Mind you, all of this is from the perspective of a capitalist framework. As I said before, I would much prefer a national single payor system, but I don’t have that yet. I have to work to help people get covered with the tools I have available, and the ACA is not bad for that

@N_Boyajian @Steph_lly How did I write it off completely? It made healthcare affordable for a number of people, but it did so by funneling even more public money to private health insurers. We can also make gas more affordable by giving oil companies even more money. But this is not a structural change

@Karl_Was_Right @N_Boyajian The structural change is called Risk Adjustment, if you haven’t heard of it I would recommend reading up on it. It’s really a really fascinating system

@Karl_Was_Right @N_Boyajian You didn’t write it off completely I dunno what he is saying. The subsidies aren’t the structural change. The change was the ACA changed the incentives for private insurance to cover benefits for the extremely ill! That didn’t happen before. I wasn’t covered before bc asthma!

@N_Boyajian @Karl_Was_Right It is fair to have complaints about the ACA! It’s wasn’t enough *but the political climate of this shithole does not afford any chance of a fully reformed national healthcare system. The left has been able to work around that with *just okay* regs with ACA and MCD expansion

@Karl_Was_Right @Steph_lly Dude it’s completely fair to say ACA wasn’t enough and prioritized working with private insurance; but writing it off completely just shows contempt for disabled and young. Also, it was a moderate* GOP plan for a blue state; not a conservative plan for nationwide implantation.

@Karl_Was_Right @miiryos Do you know how the subsidy structure works? Would you please explain?

@Steph_lly @miiryos That’s just to qualify for the subsidies. That doesn’t mean the actual amount received is anywhere near adequate enough to make it affordable. And again, not a structural change to actually undermining the employer-based system or bringing costs or rent-seeking from insurers down

@Karl_Was_Right @miiryos The issues they you have with the ACA are not because the ACA is actually bad policy, you’re just looking at it from a narrow perspective and don’t see how it’s actually changed things so dramatically. You have yet to bear any evidence for your claims

@Boon_doggl @Karl_Was_Right @miiryos There was a structural change! It just didn’t happen all at once. I know it can be hard to see that because of all the other glaring issues in our healthcare system-medical student debt, excessive hospital administration spending and mismanagement, rural primary care collapsing

@Steph_lly @Karl_Was_Right @miiryos I think most Americans think they don't want it because the democrats chose to use Mitt Romney's neoliberal healthcare plan and pretended it was the best thing they could possibly get. That's what I'm saying, there was no structural change! The ACA was a band-aid and they knew it

@Karl_Was_Right Given what I’ve posted about the ACA, it’s obvious how I think about this. However, I do think the biggest failure of the ACA is regulating cost of care, specifically pharmaceuticals. The way pharmacy related health care is currently structured is absolutely evil.

@Steph_lly The ACA is primarily a massive subsidy to private health insurers. It was a conservative plan prior to being adopted by Democrats

@Boon_doggl @Karl_Was_Right @miiryos Oh I agree 100%. The real answer unfortunately is most Americans don’t want a nationalized healthcare system because they have been brainwashed to believe socialized medicine is bad. “Waiting 8 months for a procedure is bad” meanwhile they already wait longer than that

@Steph_lly @Karl_Was_Right @miiryos If we are already going to massively increase federal oversight and psend this much money why do we have a private rentier class in the middle siphnoning money out of the system? All the ACA reforms would not have even been necessary had they actually just created a nat'l system

@Karl_Was_Right @miiryos The ACA isn’t perfect by any means, a single payer system would be far better, but saying the ACA accomplished nothing to address these issues is factually incorrect

@Steph_lly @miiryos It’s not bad but it’s not really good either, and it’s certainly not a structural change. It does nothing to address the cost issue and if anything makes it worse because health insurers can still price gouge and make huge profits but now with public money

@Karl_Was_Right @miiryos Do you have examples of these work arounds?

@Steph_lly @miiryos Health insurers have already found multiple ways around that through how revenue is classified and accounted while still having wide discretion on the grounds for denying or only partially paying out claims. Aka “rules” with few teeth in terms of actual enforcement mechanisms

@Karl_Was_Right @miiryos The subsidies are based on income- subsidies are available to those within 400% of the FPL (still low but it’s better than nothing). The introduction of ICHRA helps to shift the employer-funded insurance coverage to the market place as an alternative to traditional EB insurance

@Steph_lly @miiryos It also does nothing to change the fundamental issue of employer-based health insurance given the costs of ACA-subsidized plans on the private market are still extremely high unless you fall within a very narrow income bracket