Earlier quoted context omitted.
I'm a Londoner who voted for Khan. There's a difference in that contrary to all the scapegoat stuff in the right wing press, Khan has had largely sensible middle of of the road policies. And where he has deviated from the average, on air pollution, it's been stuff I'm in favour of - I have desire to get sick/die from that. Mamdani seems like a nice guy but some of his policies seem a bit bonkers - state owned retail…
Isn't it proposing running like five grocery stores to test? That's not bonkers or radical. Or even expensive. It seems like the type of experiment HN would love.
Zohran Mamdani wins the New York mayoral race
761–770 of 1001 posts
Re: Zohran Mamdani wins the New York mayoral race
#762Mamdani's and by extension, his voters', ignorance about the effects of price controls in markets will be an interesting real-time political experiment. When the inevitable unintended outcomes become to emerge who will be blamed? https://rentguidelinesboard.cityofnewyork.us/resources/apart... https://www.zohranfornyc.com/platform Quoting Paul Krugman (Nobel prize winner and liberal columnist at the NYT). "The analysi…
Good points. All variants of rent control etc. have been tried in Europe and have miserably failed. Quite the opposite, rents have been rising even more, and new construction has been reduced due to new politically induced risks. Examples: Berlin, Barcelona But as Barcelona shows, there is a feedback loop benefiting leftist populist politicians: Higher rents, lower housing supply -> people frustrated -> leftist popul…
But they always think this time it'll be different I guess.
Re: Zohran Mamdani wins the New York mayoral race
#763Earlier quoted context omitted.
No that is a huge failure. That is perhaps the biggest failure of Obamacare. That means I, as someone with healthy lifestyle habits, has to pay largely the same premium as someone who smokes, is obese, and doesn't exercise. And sure enough, life expectancy in the US immediately stalled after the law's implementation: https://www.macrotrends.net/global-metrics/countries/usa/uni... . Exactly what economics would predic…
US policies wouldn’t affect the life expectancy in the UK, which has broadly the same trend: https://www.macrotrends.net/global-metrics/countries/gbr/uni... This is despite no-one paying (directly) for health care. Would you be willing to submit to invasive investigations into how you live to identify any risk factors you have (both under your control, like choosing to drive, international travel, and not under your…
this is mostly about drawing a line between the tradeoffs of costs and the benefits of increased lifespan and better quality of life. almost no-one actually believes all of societies resources should be committed to healthcare to achieve some small marginal health gain. claiming people are inhuman because they want to draw the line differently is messed up.
Re: Zohran Mamdani wins the New York mayoral race
#764Earlier quoted context omitted.
I'll give you one reason, among many, it wasn't a failure. It made it illegal to deny people health insurance coverage based on pre existing conditions. That was a big step forward in a broken system to restore some humanity to the system.
Had the ACA gone further and actually provided a single payer system, I'd consider the block on denials based on preexisting conditions a win. As it is we have a system of private "insurance" that can't consider the risk level of those being insured. All that means is the companies charge everyone else more to subsidize the cost of those who are more at risk. That bastardizes the whole point of private insurance. I d…
Literally the purpose of insurance
Re: Zohran Mamdani wins the New York mayoral race
#765Re: Zohran Mamdani wins the New York mayoral race
#766Earlier quoted context omitted.
>Had the ACA gone further and actually provided a single payer system, I'd consider the block on denials based on preexisting conditions a win. Your other option was to continue as things were, with fewer people getting less healthcare. Would that have been more of a win?
Yes, either we have a risk-based insurance system or we have a single-payer system that isn't insurance at all. Being stuck in the middle is worse than both extremes in this case.
Re: Zohran Mamdani wins the New York mayoral race
#767Earlier quoted context omitted.
Health insurance that can discriminate against people based on pre-existing conditions rapidly becomes health insurance you can’t use. Sure, it’ll be cheaper for a few years. Then, with non-negligible probability, you’ll develop a serious condition. At that point the cost becomes anywhere between “high” and “infinite”. If the point is just “private insurance is dumb”, sure, I mostly agree.
It isn't insurance if the provider can't consider risk factors for the policy though. If we don't want people's health to be dependent on insurance that's fine, but we should replace it with a system that isn't based on risk at all rather than bastardizing something that still sort of looks like risk-based insurance.
Insurers are welcome to consider risk factors... for populations in aggregate.
It turns their actuarial models into population-subset models instead of individual models.
Which is easily the most "fair" (to individuals) option.
Allowing insurers to consider individual risk factors (preexisting conditions, genetics, etc.) would make the advertising data mining industry seem quaint. And I don't think any American wants to live in that world.
So we can talk about whether insurers should be able to offer lifestyle incentives (yes!), preventative care incentives (yes!), and be backed by catastrophic reinsurers (like mortgages, maybe)... but enrolling people blindly is one of the best things ACA did.
(Unless one happens to be young, rich, family-less, healthy, and have no moral compunction about fucking others over for ones own benefit)
Also, important unremarked benefit of ACA -- capping maximum insurer "administration" costs.
Firsthand from inside the industry as it was implemented, I can tell you that drove efficiency improvements inside insurers, as they couldn't bill for broken, slow, manual processes in additional premiums.
Granted, it caused other problems (attempts to self-deal and harvest profits through quasi-related provider / pharmacy entities or Medicare Advantage), but it did focus insurers on being efficient facilitators.
Re: Zohran Mamdani wins the New York mayoral race
#768Earlier quoted context omitted.
I'll give you one reason, among many, it wasn't a failure. It made it illegal to deny people health insurance coverage based on pre existing conditions. That was a big step forward in a broken system to restore some humanity to the system.
This is a bit of an aside, but why isn't medical tourism more popular in the US? If you could set aside a couple tens of thousands of dollars, as a rainy day fund, you could get close to the very best possible care for even serious conditions from countries that have highly developed medical tourism sectors. Granted, I acknowledge, that the US will likely still provide better care at the absolute high end, and asking…
For starters, American insurance has a "maximum out-of-pocket" amount, which means the maximum you can possibly pay for healthcare costs. My plan, from just a regular unknown company doing boring things, has a maximum out of pocket of $5k for an individual. So there's no scenario where I'd ever benefit from spending "a couple tens of thousands of dollars" because even if I spend the whole year in an ICU bed at a cost of millions of dollars to the hospital, I only pay $5,000.
Also, "a lot of people either bankrupt themselves, and end up paying much more than that" doesn't make sense. Declaring bankruptcy means you don't pay the debt, you wouldn't pay a lot AND declare bankruptcy. You'd see the amount was too much to pay, declare bankruptcy, and have the debt wiped out.
Keep in mind that millions of Americans have essentially no assets that aren't protected in a bankruptcy (car, home and retirement accounts are generally safe). It's not like millionaires are going bankrupt from medical costs, it's people who had nothing to begin with declaring bankruptcy when they got hurt while uninsured and going back to zero (instead of negative).
The real problem of the US system isn't the subsidies for the poor, it's the opaque, convoluted billing system between insurance companies, pharmacy benefit managers, and providers. Billions of dollars are siphoned out of the system as profit to insurers and hundreds of millions are wasted on salaries for the bureaucracy of managing the billing system.
Re: Zohran Mamdani wins the New York mayoral race
#769Earlier quoted context omitted.
Manchin and Sinema shouldn't be mentioned together in the same sentence. Manchin was genuinely the best Democrats could hope for from West Virginia. Sinema was absolutely not the best Democrats could hope for from Arizona. Manchin was also, while not perfect, more honest in much of his opposition than Sinema was, and sometimes he was actually right.
> Manchun was genuinely the best Democrats could hope for from West Virginia. Sinema was absolutely not the best Democrats could hope for from Arizona Sure. My point is both are preferable to a MAGA enabler. If you lose perspective and start aiming for perfection at the expense of the good enough, you lose power.
This is a part (far from all, but a real part) of why they turned to someone who claimed to be willing to get things done—even if he had to break rules to do it.
I'm not going to say that I wish those seats had been filled by Republicans, instead, because I don't know how much worse that would have made things. It's very possible that we still would've gotten 2 Trump terms even so.
But I don't think it's fair to paint them as unquestionably better, when the second-order effects are real, and, while impossible to measure, potentially devastating.
Re: Zohran Mamdani wins the New York mayoral race
#770Earlier quoted context omitted.
I think people had rose colored glasses about Obama because he was, by far, the most charismatic President we've had in modern times. His speeches still give me goose bumps, even when I disagree with what he's saying! That man has the gift of gab. Him also being intelligent further, sadly, makes him an outlier in modern times. But many of the things he did were dubious and ACA is a perfect example of this. It's littl…
The ACA was, I believe, a highly intentional better-done-than-perfect effort, fully cognizant of the historical cycles of political will around major healthcare policy in America. If you review in depth the efforts in the 90s under Clinton, and earlier under Johnson, I think the approach was well considered. A more ambitious policy proposal ending in failure very well may have have put the topic to bed for another tw…