Nvm, Grant tried to run in 1880. I am a fool.

It's important to remember that ACA enrollees are not typical income earners. The vast majority are working class.

They also share a marketplace with older entreprenuers. It creates unintuitive issues like the subsidy cliff fix resulting in small coverage gains nonetheless.

Just got off work!

Yea, I mean the subsidy cliff is terrible policy and I don't think it should exist. But if a critical mass insists on it, you can still keep more than 90% of coverage gains if you keep the eAPTCs <400% poverty.

Democrats didn't funnel subsidy dollars directly to insurers because of their great love for industry. It's just the approach that's most user-friendly and administratively efficient.

Better in 2024 than 2023, still historically bad

Still a massive problem.

3) little to no out of pocket costs*

Amy Finkelstein advocated for a version of something like Medicaid for All where you'd have to buy private coverage to leave. Like Australia. Less like Canada, where you can' REALLY leave unless you count some stuff Alberta or Ontario are considering.

I think the Swiss model (I lump the ACA in here) was a fine choice in 2010. And I think people underestimate it's generousity for some people (Silver+CSR can be better than base Medicare, Gold like base Medicare).

But you can do more for people in other models. Though can do universality in any.

4) Government funded HSAs with supplements (Singapore)

5) Pre-ACA with some HSAs (not universal)

Alternative models to the ACA:

1) the NHS/socialized medicine

2) National health insurance with private supplement (Medicare, France, South Korea, etc) [OOP max sold separately?]

3) Medicaid for all (Canada if no private opt out, otherwise Australia?)[state-run, little to no OOP max, networks?]

Asteriks:

Enhanced ACA avoids more issues like the subsidy cliff

Bronze plans aren't a thing in Switzerland. You'd probably only find Platinum, Gold, and maybe Silver.

No massive age band, but see asterisk 1.