Repeal or replace?

EdwinA said:
Because it was a nice middle class profession. You obviously know zero history; the middle class before the 1950's was pretty small, and colleges weren't cheap outside of NYC. For instance, the average railroad worker in 1910 made maybe $500-$600 a year. Those were 'good jobs' then, Meanwhile the average doctor made around $2,000-$5,000 a year, not rich by the standard then but substantially better than the average prole, who made up 80% of the population. 'city wages were higher, but then so were prices, so in many case they were worse off than rural workers.
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It meant success huh
 
evince said:
Why did nearly all parents want their kid to become a dr for hundreds of years in this nation? Because it was a guarantee of success
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:rofl2:

No, that's not true. The claim appears to be a hyperbolic or misremembered exaggeration, likely stemming from modern stereotypes about "Asian tiger parents" or immigrant families in the U.S. pushing kids toward medicine (or STEM fields in general). Here's a breakdown with historical context:Historical Reality in the U.S. (the "nation" implied here)
  • Pre-20th century (1600s–1800s): For most of American history, the vast majority of parents were farmers, laborers, or tradespeople. They wanted their children to inherit the family farm, learn a trade (e.g., blacksmithing, carpentry), or marry into stability. Medicine was a rare, elite profession—often requiring apprenticeship and not seen as accessible or desirable for "nearly all" families. In colonial times, only about 1 in 1,000 people were physicians, and many were untrained or quacks. Sources like U.S. Census data from 1850 show ~40,000 doctors nationwide, vs. a population of 23 million, with most kids apprenticed in agriculture or crafts.
  • Early 20th century: Industrialization shifted priorities to factory work, business, or clerical jobs. The GI Bill after WWII made college more accessible, but even then, popular aspirations were engineering, teaching, or law—not universally medicine. A 1940s Gallup poll on parental hopes for sons showed "business owner" or "engineer" topping lists, with doctor in the top 10 but far from dominant.
  • Post-WWII boom (1950s–1980s): Medicine became more prestigious due to antibiotics, vaccines, and higher pay (average doctor salary ~$100k in today's dollars by 1980). But surveys (e.g., from the National Opinion Research Center) consistently showed only 5–15% of parents naming doctor as their top choice. Common picks: engineer, lawyer, teacher, or "successful businessman." Farming still lingered in rural areas.
Where the Stereotype Comes From
  • Immigrant communities (especially post-1965 Immigration Act): Many South Asian, East Asian, and Middle Eastern families did emphasize medicine (or engineering/law) due to cultural values, limited opportunities in home countries, and the U.S. "model minority" path. For example, Indian-American parents in the 1980s–2000s often pushed STEM hard—today, ~10% of U.S. doctors are Indian-American despite being <1% of the population. But this is a subset, not "nearly all parents" nationwide.
  • Media amplification: Shows like The Cosby Show (1980s) or modern memes about "pre-med" kids exaggerate it. A 2020s viral tweet or Reddit thread might claim "every Indian parent wants a doctor," but that's anecdotal and culturally specific.
Evidence Against "Nearly All" or "Hundreds of Years"
  • Longitudinal data: U.S. Department of Labor stats and historical polls (e.g., Harris, Gallup since 1930s) never show medicine above ~20% as a parental preference, even at peaks. In 2023, a Pew survey had only 8% of parents hoping for doctor specifically.
  • Diversity of aspirations: For centuries, class, region, and race dictated hopes—enslaved people wanted freedom, immigrants wanted citizenship/stability, working-class families wanted union jobs.
  • Counterexamples: In the 1800s, "nearly all" Mormon parents in Utah wanted missionaries; in the South, landowners wanted planters. No universal doctor push.

 
G48CeGuXEAAHDTy
 
EdwinA said:
It's what pays for all those big hospitals and big HMO offices and drug company dividends. Most Americans couldn't pay current rates out of pocket, and Medicare is the giant piggy bank for many big corporations. Most of them go broke if Medicare was to fail.
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Hospice switched a family member from a good Aetna program to Medicare, and she got fabulous care until she died.
 
evince said:
Where did you scrape that up from? The dog park side walk?
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The Biden Administration, leveraging Democrat majorities in both chambers of Congress during 2021 and 2022, enacted and extended temporary enhancements to Affordable Care Act (ACA) premium subsidies that effectively masked the true extent of rising health insurance premiums for higher-income enrollees.

Under the original ACA framework, premium tax credits were available only to households earning between 100% and 400% of the federal poverty level (FPL)—roughly up to $54,000 for an individual or $111,000 for a family of four in 2021.

Households above that threshold faced the full brunt of escalating premiums, which had been climbing due to factors like increasing medical costs, hospital prices, and insurer risk adjustments.

However, the American Rescue Plan Act (ARPA), signed by President Biden in March 2021, eliminated this income cap entirely while also boosting subsidy amounts across all eligible levels, capping out-of-pocket contributions at no more than 8.5% of income for benchmark plans.

This change, passed via reconciliation on a party-line vote with Democrats holding a slim House majority and a 50-50 Senate (broken by Vice President Harris), made subsidies available to anyone whose premiums exceeded that income threshold, including high earners previously ineligible.

For higher-income ACA enrollees—those above 400% FPL, often professionals or small business owners paying full price pre-2021—the ARPA created the illusion of affordability.

Premiums for marketplace plans rose an average of 4-7% annually during this period, driven by broader healthcare inflation, but the new subsidies absorbed nearly all increases.

For instance, a 60-year-old couple earning $85,000 (just over 400% FPL) might have seen their unsubsidized benchmark plan premium jump from around $1,200 monthly in 2020 to $1,400 by 2022, yet their post-subsidy cost dropped to under $600 monthly—or effectively zero for many plans—thanks to federal credits covering 60-80% of the bill.

The administration's messaging amplified this, with Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) touting that "four out of five enrollees" could find plans for $10 or less per month, a statistic that held true only because of the hidden taxpayer-funded backstop.

Critics, including Republican lawmakers and policy analysts from groups like the Paragon Health Institute, argued this shifted the burden onto federal spending—ballooning from $34 billion in 2021 to over $100 billion by 2024—without addressing underlying cost drivers like drug prices or provider consolidation.

The temporary nature of ARPA's subsidies (set to expire after 2022) was downplayed in public outreach, with Biden's team framing them as pandemic relief rather than a structural fix, allowing enrollees to perceive stable or falling costs amid actual premium hikes.

In 2022, with Democrats retaining their congressional edge (a narrow House majority and 51-49 Senate after the Georgia runoffs), the Inflation Reduction Act (IRA)—another reconciliation bill signed in August—extended these enhancements through 2025 without Republican input.

This bought three more years of subsidy insulation, further obscuring premium growth for high earners.

By then, enrollment had doubled to over 16 million, with about 20% of new enrollees being higher-income households drawn in by the "no cliff" policy.

Yet, insurers baked in expectations of continued federal support when filing rates, leading to a feedback loop: subsidies encouraged higher list prices, which in turn justified larger credits.

For a family of four earning $130,000 (above 400% FPL), a 2022 benchmark premium might have risen 5% to $1,500 monthly due to factors like GLP-1 drug costs and post-pandemic utilization, but IRA subsidies reduced their share to around $900—less than under pre-ARPA rules—while the government footed the rest.

The administration's CMS fact sheets and enrollment ads focused on "record-low premiums" and "savings for millions," rarely disclosing that these were propped up by $64 billion in additional spending or that expiration loomed in 2025, potentially exposing enrollees to 75-114% average increases.

This approach hid costs from higher-income enrollees by design: the subsidy formula automatically adjusted to absorb rises, preventing "sticker shock" at checkout on HealthCare.gov, while public narratives emphasized accessibility over fiscal trade-offs.

Substantiation comes from nonpartisan analyses like those from the Kaiser Family Foundation (KFF), which show that without these enhancements, high earners would have paid full freight on premiums up 20-30% cumulatively from 2021-2022 due to market dynamics.

The Congressional Budget Office estimated the extensions added $383 billion to deficits over a decade, disproportionately benefiting middle-to-upper-middle-income groups (e.g., 1.5 million enrollees above 400% FPL by 2024) at taxpayer expense.

By structuring the policies as short-term and bundling them into massive reconciliation packages amid economic recovery, the Biden team avoided standalone debates on the long-term price suppression, leaving enrollees unaware that their "affordable" plans relied on a temporary veil over systemic cost pressures.

As a result, when open enrollment previews for 2026 emerged in late 2025—post-expiration—many faced projected doubles in out-of-pocket costs, revealing the hidden escalation only after the Democrat window closed.


 
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