> The ACA was a starting point -- the most that could be passed in the face of "the Party of No" that from the initial days of Obama's presidency declare total obstruction to be their over-riding, primary policy objective and political strategy.

Bullshit. He could have pushed for a single payer plan but didn't have the balls. Caving in to the insurance companies and lobbyists so early on in his presidency was a sad sign of how the rest would play out.

The Democrats had the House, a super majority in the Senate, and the POTUS. They had the one chance to do it and either didn't have the cajones to move forward with it, or, more likely, have too many hands in the pockets of insurers and big pharma. Good luck getting that to happen again.

> Like any law and program -- just like those in private sector business -- it required management and improvement. Unfortunately, we instead got obstruction.

The starting point was the worst possible combination of public + private sector. Obstruction is the only thing that has kept the tentacles of the ACA from further rooting themselves in the American healthcare system.

> Law and regulation aren't magic, and they aren't "set and forget". You have to manage them, just like everything in this world.

You also have to hold representatives, senators, and the executive branch accountable which is what happened in the 2010 elections and more recently in 2016.

> I agree that traditional group insurance should not be separated from the individual market. Insurance companies shouldn't be permitted to cherry pick, neither by population selection nor by pricing. Frankly, I don't see private profit as basically compatible with what I see to be a public investment in the public's health. But with law and regulation, we seem to get at least partway there.

And the ACA did nothing to make that happen. Arguably it made things worse as companies could point individuals to the individual market and say, "Hey you can take care of yourself with an overly expensive plan from there now".

> In short, in my personal, anecdotal experience, I've found opponents of the ACA to be irrational people acting against their own self-interest. And selfish people, who take aid and have no concern for the next person who's going to come along and need it.

I'm adamantly against the ACA and I'm far from irrational. If anything I'd classify myself as hyper-rational.

I'm fine taxes going toward a single payer plan.

I'm also fine with eliminating insurance for routine healthcare and returning to a direct payment for service model.

The middle ground we're at now where we dump the expense of the high risk portion individual market on the self employed is what doesn't work for me. You end up with people paying $12+K per year in premiums for nothing (since their deductibles are $5-7K as well).

> And while the ACA is far from perfect and has had to struggle, the preponderance of rhetoric against it is equally ill-informed and selfish. IMO and experience.

> It was born in Massachusetts under the Romney government. Nationalized as the ACA, it was meant to be a middle of the road proposal that left the existing powers in place. It was proposed as a first year initiative at a time when not just individuals but businesses were making great outcry about increasing health care expenses -- year upon year double digit percentage increases in insurance premiums -- saying they wouldn't be able to compete with businesses in other nations having national health care and so much lower health care costs. It was obviously planned and queued up before the Obama campaign and nascent administration were made aware of the full depth and severity of the financial crisis. (Something for which I am still upset with Obama for not turning the FBI and Justice loose as was done in the wake of the Savings and Loan scandal in the '80's.)

> Republicans initiate their selfish, self-serving doctrine of "No". ('We're going to make his a one-term presidency.' That was not just their politics but their operating policy.) They label the health care initiative "Obamacare". They make up the incendiary, false rhetoric of the supposed "death lists" that would be forthcoming.

If they didn't do that we'd be deeper in the ditch that it's digging for our healthcare system with even less chance of digging out.

> They, up through Trump's election, eight years later, have presented no and have no sign of possessing any alternative plan for health care. Despite the endless rhetoric that they would "fix" health care.

> All it's offered is a big pack of lies.

I'm disappointed at the alternatives offered so far though I do feel that even eliminating the ACA with no replacement is an improvement in my book.

My own idea is to:

- Ban employer provided health insurance.

- Eliminate tax deductions for companies providing health insurance for employees.

- Allow individuals to deduct premium payments (up to a cap)

- Require insurance companies to offer all plans publicly to all takers.

- States can mandate insurers cover wide ranges of the State rather than pick their own zones

This would lead to a single risk pool (per region covered by an insurer) with competition between insurers. It would also level the field for the little guy because he would be able to get coverage at the same terms that big business is supplying it for their employees today.

Net winners are:

- High risk individuals get to be part of a much bigger pool (lower $$$)

- Individuals on individual market get to be part of a much bigger pool (lower $$$)

- Completely separates health insurance from employment (seriously who's stupid idea was that?!)

- Small businesses (don't have to compete with big corps who can offer cheaper coverage)

- Entrepreneurs (insurance isn't tied to employment so can quit working for big corp without losing coverage)

Net losers are:

- Insurers (have to actually compete with each other)

- Insurers (they're product becomes a commodity)

- Insurers (have to offer flat pricing to everybody)

- Insurance salesmen (no more corporate policies to sell though I guess they can sell individual ones)

- Large corporations that previously were self-insuring (can't leverage their large employment base to get lower insurance costs)

- Employees at large corporations will pay more for health insurance but it won't be like the ACA premium increases as it's spread across 100M people.

That's the only plan I've come up with that can lower costs, cover everybody, and does not involve a single payer system.

As a bonus, having a "Federal Health Care Insurance Company" that acts as a competitor of last resort might lower costs further but it's not strictly necessary.