Did you know that 2.5 millilon employees work in healthcare insurance and that a single payer option would probably reduce that in a huge way, creating a massive group of unemployed people? There are dozens of major insurance companies who, in the course of daily business operations, duplicate the work that is being done at competing companies. Obviously, Blue Cross' accounting department isn't going to do the accounting for Cigna, and so you get two accountants doind the same parallel work multiplied across all the companies. But if the US Gov't is going to do all the work in a single payer system, you'll have a massive cut in employment. No way around it. I don't think people realize that the sudden disappearance of probably 1.5 million jobs will be a reality in that case. Esepcially not Trump who has advocated for single payer and ran on a major employment focus.

But, as a Libertarian, healthcare is a strange beast. They have a moral obligation to give away their services to those who need them, and this has often been given as a reason why they don't fit into the 'free market' argument. But that 'given away care' only adds up to 39.5 billion. To put it in perspective, those costs are less than 6% of a hospital's costs, and should only add up to a significant, but not untenable price increase to the end user. Of course they're not evenly distributed costs, some hospitals are going to see higher costs than others based on demographics. But in a separate study (where the numbers are less than 6 percent in the first place) they found that the worse-off hospitals (top quartile) spend 2.73% or more on charity care, and 3.49% on bad debt (people who don't pay). So those numbers are simliar. Even if we say that on the aggregate hospitals pay 10% to give to charity care and bad debt, then we still can't justify why healthcare costs so damn much.

The ACA was a mess, and the experiment failed. Costs went up, way up. Certainly there were more people covered, but in one of the only analyses of multiple streams of information and not just a survey, Goldman Sachs came to the conclusion that there were 17 million people insured by 2015. But, of those 17 million, 11 million were gains from the expansion of medicare. 2 more million were from aging into medicare. 3 million were the ones who actually purchased insurance that didn't have it before.

But there was also this legal mandate that made it mandatory to get insurance of suffer a penalty. Also, a lot of people were able to stay under their parent's insurance until they were 26, and they were counted as well. So how many people who had pre-existing conditions and couldn't get insurance before actually got it as a result of ACA? I've heard anecdotes, but has anyone seen the numbers?

So if we want to solve this whole thing, it seems like there are some problems that we've been talking about as if they're true, when they aren't. 20 million people aren't about to lose covereage.