Objectively intelligent.

[Greedy,Greedy,Greedy]

Originally Posted by sebastian_dangerfield

Bending the cost curve was part of it. But since the days of Ted Kennedy seeking a HC bill, the primary aim was getting HC to those who couldn't afford it. A huge percentage of that category is people who could not make any meaningful payment toward it. So they were near entirely subsidized.

This dog don't hunt.

Huge portions of the bill related to controlling costs and bringing costs down for everyone. Some of those provisions never got to be fully implemented because of Republican challenges or failures to fund. But you find that growth in healthcare costs in 2013-14, the years when ACA provisions were most robust, had been cut by 50% over the immediately preceding years.

The goal has always been threefold: affordable, quality, universal coverage. All three are reflected in the bill.

If we could have focused primarily on lowering premiums for people able to pay something and willing or already doing so, without using those dollars to subsidize care for people paying nothing, you could have put a lot of money back in working middle class peoples' pockets or given them far more bang for their HC dollar.

It is actually much, much harder to cut costs without also addressing the uncovered. What made ACA work was increasing the total pool size nationally; without that increase in pool size, controlling premiums is much more difficult. That cuts costs in the insurance component of care rather than in the care itself, so it gets you cost cuts without affecting quality. Now, if you want to regulate for-profit hospitals like utilities, eliminate patent protection for drugs, or cap physician salaries, you may be able to cut costs without a pool expansion, but those things are not only politically challenging, they are also constitutionally questionable and can have direct impacts on quality of care.

Now, of course, there are social reasons not to do this. But the question at hand was whether the ACA was primarily aimed at helping the middle class. I think it was secondarily aimed at helping them.

You know repeating something wrong won't make it right? But thanks for playing.

That's your view. I think the labor market changes afoot, which I mentioned, were #1, then the economic crisis was #2, then inequality caused by policy reactions to the financial crisis was #3, then the environment was #4, then HC was #5.

That's just your view, and one not shared by many people. Meh.