I can't argue the point that the news is biased (on either side), but why would you call it fake news? Can you tell me exactly what you mean by that? Also, bear in mind, I don't watch news, I read it.
Oh indeed the term itself is a buzzword and it probably isn't the most precise term. I think it fits however, in that news has to be held to a very high standard of objectivity to have any value.
The problem is that almost no media, print media included, reports facts on major political discussions without at least some editorializing, to the point it's not even subtle or debatable that the intent is there any more. I mean when Noam Chomsky of all people calls the NYT "pure propaganda" you have a problem.
Information which is presented as objective reporting, but which uses rhetorical tricks, deception or strategic omissions to predispose the reader to a desired conclusion (one dictated by the report's creator), is presented in bad faith. So I think the term "fake news" is entirely fair, sure it's news, but there's something very disingenuous about it.
Now, the ACA. Holy crap I'm loving the discussion. And I completely get the free-market argument. For some reason though, health insurance seems like an exception
Okay not discussing as fake Republican here, just my opinion.
My first question in response to this statement of exceptionality is why is it an exception? I know you elaborate more on this, but the fact you can't really say why here is illuminating and props up a point I will make below.
(especially with what the state of the healthcare system was before the ACA).
I just want to stress this was a system which the government created with a free market component, not an actual free market. Granted, a lot of it was completely unintentional (most of the mess we're in now is a holdover from WW2 era wage controls), but it's worth pointing out that there hasn't been a "free market" in US healthcare in my lifetime (again I'm 36). The government dictates what we can/must get, gives advantages to employer provided plans, who can be included, etc. and that's been in place all my life.
There doesn't tend to be the ability to act economically rational thought when one's health is involved.
Well, consider this. If I want to buy a pillow, I can go on say Amazon or dozens of other sites, look up pillows, compare prices, compare reviews, and I have all this information at my fingertips. It's not perfect but it tends to work pretty well, I usually will wind up with a satisfactory pillow.
The same is true for non healthcare services. When I hired movers recently, I was able to compare and contrast many services quickly and the movers, even ones I didn't hire, were eager to quickly inform me what I would pay and the conditions of their service, etc.
Healthcare, since it's not sold freely like this, cannot be purchased in this way. If I call a physician and ask how much a standard annual examination is, they won't be able to tell me. They have no idea. Similarly if I need a surgery on my knee or something, there is no calling three different providers and getting quotes.
But the reason it is this way is because we have forced it to be this way. Left alone, healthcare would resemble other goods and services and would behave the same way.
Remember above when you said it seems like an exception? That's because it's been artificially forced to be an exception, and it's been that way so long we don't even realize it any more.
And I know that one of the stated goals was to reduce health-care premiums, but I never really did buy that. I also thought that the stats relating to 'number of insured Americans' seemed to stop there.
And that's an issue I have with the ACA: health care is not health insurance. Health insurance is a service where the overall costs are reduced for a group of people who pool risk. It doesn't work when you're not allowed to exclude people or charge them more for the higher risk they represent, because if everyone's included your actuarial assumptions go off the rails. Costs don't go down when health insurance is used as the coverage vehicle, they go up, because that's how insurance works: the more uncertainty and greater risk in the insured, the higher the prices will be.
I personally thought the point was to focus a lot on preventative care, reducing the cost of things that increase quality of life, and decrease costs of treatment if caught early. That was the main thing I truly love about the ACA. It was the things it required as a base level of care. These things weren't available, especially considering that the vast majority of insured folks received it through their employer. So I don't think the free-market worked all that great (not with this population anyway). The power dynamics were just too off.
Two points:
Most people don't have cancer (for example), so widespread diagnostics is a waste of money. Also, not to conflate the issue too much, but it's the over use of unneeded tests being used to pad bills (especially when the government is paying) and protect doctors from lawsuits which is driving costs up.
As I said above, a free market for healthcare hasn't existed in my lifetime. You can't attribute the problems to a system that was never really implemented.
Add in the fact that ERs cannot turn away someone, we've already got things in place that suggest a base level of 'morality' for this country. We're not willing to let people die. Why not make it cheaper by reducing the number of emergencies?
Which could be done by driving the cost of basic medical care way down, which isn't going to happen under the ACA or what preceded it.
Now for the record, I do favor the free market, but Thomas Sowell has taught me that one problem with free markets is that unrestrained actors can ignore external costs. In this case, the external cost is people who are forced to default on medical bills they cannot possibly pay due to circumstances beyond their control. The fact is, we do pay for the healthcare of very sick people regardless of what we do, so most of my ideas about how to fix this basically assume an 85-95 percent free market and the rest would be a provision to basically deliver the medical care to unfortunate people at no cost to them because it's cheaper for the public to just pay for just their health care rather than their health care plus their bankruptcy procedures (to say nothing of other considerations).
I think most of us agree something has to be done for certain people, but hard cases make for bad law. You shouldn't build an entire system as if everyone is this unfortunate.
In fact, you shouldn't "build" a system at all, you should let one emerge and then react to it only in economically rational ways and think very carefully about what you do, using reason and data rather than listening to lobbyists. That includes not giving health insurance to people who are a poor fit for health insurance due to the risk involved, and not charging high risk people (like me!) the lowest rates, etc.
I personally can think of a couple ways we could harness the power of a free market to bring the costs way down while still protecting that small slice of vulnerable people who might have difficulty paying for their care under this system, but the point I'm getting at is this kind of thinking is not even on the table in Congress because what I'm calling for is let's allow a better system to come into being and then iterate public policy rationally. You'll never see these kinds of ideas get any serious political traction.