> The reality is the ACA allows insurance firms to sell obscenely over-priced plans to consumers.

As far as I am aware, the ACA actually introduced limits on how much mark-up health insurance can have, where 80% of the cost must go to actual medical expenses, and administration, marketing, etc must be no more than 20% total. So how is the ACA the cause of insurance mark-up?

I think the actual root of the problem is not mark-up but that health care in the US is quite expensive (and always increasing). The ACA in some cases shifts who pays for it (young healthy people pay more), but it doesn't appear to change much the overall cost. It sucks temporarily for those younger people, but considering they will most likely become older, less-healthy people over time it doesn't seem that unfair overall.

> A sane system would have seen price controls in conjunction with the requirement for insurance.

If you are paying 4x more though, it sounds like the marketplace may be breaking down in your location with a "death spiral", where the price goes up, all the healthier people leave, causing the remaining insurance pool to be even sicker and the price going up even more. The whole purpose of the mandate was to prevent this, but it looks like it's been repealed. Price controls in that situation is hard since the pool is actually expensive to insure, I don't think the government can force the companies to sell at a loss. To reverse it maybe they could re-instate the mandate, or change it to a tax, or add a public option. Or, of course, give up on insuring pre-existing conditions.

> I would happily pay taxes for a fully nationalized system

Keep in mind, there are other countries like Germany and France that have private insurance markets and much cheaper care. I think it is fully possible for the US to implement a nationalized system that does not achieve the cost-effectiveness that we want. The VA system might be an example of how that might go.

> As far as I am aware, the ACA actually introduced limits on how much mark-up health insurance can have, where 80% of the cost must go to actual medical expenses, and administration, marketing, etc must be no more than 20% total. So how is the ACA the cause of insurance mark-up?

One of the issues (and I like the ACA generally), is that that limit removes an incentive for the insurance companies to control costs and the 20% markup becomes a floor, not a ceiling. If they get 20% of revenue as non-medical costs, and they want to increase their profit, the best way to do that is to allow medical costs to increase. Then their 20% is larger because the pie of costs is larger.

Presumably they could pass along the savings and increase revenue by expanding their market share, or lose revenue to a company that controls costs. I see your point though, and in a given year it might be easier to increase medical expenses by 5% than to grow market share by the same amount.

One thing I wonder though, is that even without the 20% rule, if the company can get away with raising rates by 5%, wouldn't it make sense for them to do so? If they started with a 20% margin that would increase their profits by a whole 25%, instead of a measly 5% with the cap, so you'd think the incentives would be even stronger. It seems like adequate competition is the most important thing in a for-profit insurance model rather than having a 20% margin rule or not.

In a healthy, actually competitive market, I think that would work, but there are so few insurance operators in each market, it's really easy for them to quietly collude with each other rather than compete. Additionally, everyone else in the industry wants higher prices and more profit. They are not limited to a 20% cost margin. The insurance companies are supposed to be the downward drivers on price. However, here, it's just easier to not fight the price increases, take your 20% of the increase, and move on, rather than fight hard to push prices down, and gain market share.

I think many economists would say that while you had an employee-based plan your costs were actually going up significantly, you just didn't see it because those increases were coming out of (what would have been) your yearly salary raises.

I don't think ACA plans are much more expensive that what we are _really_ paying for employer insurance. I recently became unemployed and when I priced it out, an ACA plan that offered benefits similar to what I would get with a COBRA plan were pretty much the same price - both ridiculously expensive, so I went with a cheaper silver HMO ACA plan. And my old employer charged a 4% "fee" on COBRA premiums as well - I guess the benefits companies want some of the action.

Again, consumers have absolutely been harmed by the skyrocketing cost of health care. But every bit of evidence shows that the ACA slowed that growth.

The only connection you’re making here is that your own costs went up after the ACA. It’s a post hoc fallacy.

> The only connection you’re making here is that your own costs went up after the ACA.

The connection is that the ACA rates, and rate-increases are out-of-touch with the employer-offered system, even when those firms are tiny and not nearing some kind of "scale" cost-savings.

I have been hollering about this issue for years, and I've yet to have someone say "Ya know, I actually experienced something radically different." So where is all this evidence you claim but can't be bothered to provide?

I'm having trouble parsing what your argument here is. Are you saying that rates on the individual market are more expensive than the large group market is? Yes, that's true, and always has been (the small group market is effectively a facsimile of the individual market, for the obvious reason that there's not much actuarial benefit to pooling 10-20 random people).

There also isn't one "employer offered" system. In addition to the aformentioned small-group marketplace, there are also large group plans that cover big companies, and very big companies often self-insure, using health insurance companies solely to administer benefits but financing the care themselves. Can you be specific about which of these kinds of health care financing have been impacted by the ACA, and how?

The ACA is a bandaid on a wart