United States Healthcare Reform

Neither party has presented any plan, including the ACA, which actually reduces the costs of healthcare. It wasn’t even a goal of the ACA.

Well the Dems have said it would save costs, bigger pool, etc, etc. Though as long as it’s run through insurance companies and the system is set up to extract as much cash as possible from said companies, I don’t see it happening.

In 2009, Obama wanted to slow growth of healthcare costs. And he wanted to improve access to healthcare.

By 2010, he realized he would have to choose one road or the other. He chose to improve access to healthcare, and saved the first for another day.

A wise choice, in my opinion.

According to the Economist, Obamacare has reduced the growth of health care costs:

Growth in health spending per person slowed from a shocking 7.4% a year from 1980 to 2009 to 3% from 2009 to 2012. It may rise again, alas. The lousy economy caused some of the recent slowdown. The government’s actuaries expect spending to jump by 5.6% this year and 6% a year from 2015 to 2023. As more Americans age and gain insurance, they will demand more health care. Shane, for example, ignored an aching shoulder and blocked sinuses when he was uninsured. Now that he has cover, he is seeking treatment. Big hospitals say they are seeing more patients: Tenet, a giant hospital firm, reported a 4% jump in patient volumes in the second quarter, compared with a year earlier.

http://www.economist.com/news/united-states/21618904-year-after-big-launch-obamacare-working-experimental-medicinehttp://www.economist.com/news/united-states/21625821-why-democrats-dont-boast-about-their-biggest-accomplishment-law-dare-not-speak-its

Well, one can always debate that it’s not the true cause of the lower growth. That’s always hard to pin down precisely. And, as they say, the increase in patients might mostly offset the lower costs. But if more people get health care for the same price, that sounds like a win too.

EDIT: Damn it, those are older articles, here are the recent ones I was looking for:

That would be a terrible shame, for Obamacare appears to be working better than expected. First, despite the incompetent rollout of healthcare.gov (the website that allows people to use the federal exchanges), the proportion of Americans who lack cover has fallen from 16.2% to 12.3% since 2009. Second, the previously terrifying pace of medical inflation has slowed. The amount that America spends on health care grew by 3.9% a year in nominal terms between 2009 and 2011—having grown by 7.3% a year in 2000-08. The trillion dollar question is: how much of this squeeze is because of Obamacare?

Not all, clearly. The economic downturn accounted for much of the fall in health-care inflation: 77% by one estimate, 37% by another. Yet Obamacare also played its part. For one thing, it may have helped trim some of the fat from Medicare, the bloated public-health scheme for the old. Many hospitals appear to have changed the way they behave in anticipation of the law. The old rule of thumb for American health care—and particularly for Medicare—was that doctors were paid for every test and surgical procedure, and so performed many that were unnecessary. The new law has provisions that encourage them to keep people well; for example, it imposes penalties on hospitals where patients are frequently readmitted. Hospitals are merging, streamlining and restraining their enthusiasm for buying all the latest expensive equipment (see article). A new paper in Health Affairs shows that they have improved productivity in the past decade, and especially since 2009.

http://www.economist.com/news/leaders/21645730-supreme-court-considers-whether-gut-obamacare-evidence-mounting-law
http://www.economist.com/news/united-states/21645855-growth-americas-health-care-spending-slowing-will-obamacare-cut-costs

There is a difference between having access to health INSURANCE (which the ACA has increased) and healthCARE, which is already suffering under the ACA. If you look at the Forbes article again it talks about how it takes longer to see specialists, doctors are limiting new patients they’re taking on, and they’re limiting the amount of time they spend with patients, while some are just generally dropping out of the medical workforce, plus there are fewer insurance options and a significant number of businesses have either stopped hiring or started layoffs because of the ACA.

There are certainly things about the ACA that I think most people, regardless of their spot on the political spectrum, can support. It just seems that the ACA is making things worse for more people than it is helping, and many of those being helped are going to receive dubious benefits.

Unfortunately I doubt whether the D’s or the R’s are going to have it in them to compromise and keep the good parts of the ACA while cutting out the parts that are most discouraging to job growth and doctor retention, etc.

Maybe we can join the rest of the world in the 1940’s and just have universal care.

Oh wait that’s Stalinism. You know, unless you’re in Congress and get the benefits forever. Then it’s more American than apple pie.

I think if the Dems win everything, we’ll get real reform here. They won’t repeat the mistakes of 2009, and will be willing to kill the filibuster if they have to.

I think it’ll be nearly impossible to win back the House; decent chance with the Senate. I think the only GOP candidate with any real chance of winning the general is Bush.

Any article that says hospital mergers have result in efficiencies and lower costs is written by someone who isn’t familiar with health economics

Hospital mergers are associated with higher costs and worse care per the evidence. NASI just wrote on this in Frbruary and been in other healt writings. The worse outcomes is one reason the FTC blocks mergers

New data that I am still parsing on post recessions spending says health care has declined to drugs going off patent and not new ones, decline in goby nursing home payments and decline in state hlth spending. The first two are biggest reason.

Read the great MSK in New York Times today. Enrollment below estimates with big concern for future. Some modelera are lowering their projection for overall enrollment due to slow take up rate. The big gains have been made. If enrollment doesn’t pick up I would expect that the risk pools are going to skew to high risk which would drive up costs. Based on some of the numbers I have seen, healthy middle income are staying out of pool. That could change as mandates bite harder.

Other data point is risk pool might not be too bad if there was a lot of dumping by employers.

NYT article is “now comes the hard part enrollment set to slow”

Obamacare causes diabetes rates to rise.

What they found was the states in which Medicaid was expanded saw a 23 percent increase in newly diagnosed cases of diabetes. By contrast, the states that decided against expansion saw only a 0.4 percent increase.

Thanks Obama.

Seriously though…

“We had people coming in earlier in their progression of their disease,” Kaufman said. “By coming in early, there’s less damage to their body caused by the diabetes, and one can attempt to slow the progression of the disease. So there will be fewer heart attacks, strokes, kidney transplants, amputations, blindness and premature death.”

Yup. And it’s radically cheaper to have people treated for it rather than ending up repeatedly in the emergency room for expensive stabilisation. (For that matter, quite a few people who are detected early will need only dietary advice)

There were/are American hospitals where they, quite literally, were treating poor diabetic people as outpatients for free…to cut emergency treatment costs.

There is a real issue with costs being passed to the consumer being a big portion of the savings. That needs to be addressed somehow. The poor aren’t as heavily impacted due to subsidies. What’s needed is a percentage-based cap on healthcare costs, so no one has to spend more than say, 15% of their total income on healthcare no matter what.

I think that the whole point of making healthcare cheaper is going to be one of those political nightmare scenarios because gains from larger and more comprehensive coverage comes in generations of people getting healthier at the intial cost of more people going to the doctor. One of those things politicians hate is supporting programs that show no real gains for many years. This is not an “easy win”.

It is going to be a bit of a burden as these providers take on newer patients, but it will end up a gain in the end as people get healthier as a whole and cost the system less down the line.

That’s a problem as well- voters are no smarter than shareholders- they tend to be short-sighted and risk-averse just as easily.

Yuuuuuuuuuuup.

In other news, I just found out that I have already hit my deductible for 2015 because just going in to talk to my doctor costs $700-1300. Jesus fuck, how in the world is anyone supposed to afford that? For a chronic or long-term-treatment condition? Insane! Even if everything goes perfectly for me this year – I am granted not in like the ideal situation but still – if everything goes perfectly the uninsured cost to me if I were to follow the suggested, responsible treatment plan would be like $9,500. Just to do follow-up treatment on the cancer, not anything else that might happen. And that’s not even with any prescriptions!

Ridiculous.

Agreed, that is the goal. But for the near period the best anyone can say is that more people are covered.

Ridiculous is a much kinder word than I would use.

Also, slightly off topic, but related to perceived health care costs and savings due to more widespread access: A while ago our government here in Spain decided illegal inmigrants should not have access to free health care (that is, except for ER procedures, since it’s a crime not to treat a sick person in an ER). Today, after three years (more or less) they have backtracked. It seems they have figured they were expending more money by denying health care than by giving it in the ER. And that’s only after a three years period.

Of course the situation in the US is vastly different (can you reject somebody on the ER there? I never faced that issue, and I don’t know), but it seems gains and cost savings are not that long term.

You can’t reject folks from the ER. If they don’t pay, the taxpayers pay some and the hospital eats much of the cost.

As for Adam’s case, at least you don’t have to worry about lifetime coverage limits anymore (which is one of the good things about the ACA- I have my issues with the ACA, but I consider it a slight positive over the old system despite the ridiculous cost-passing on to consumers. )

Oh, absolutely. Lifetime limits and never being insurable ever again outside of my employment would have been my reality pre-ACA, and it would have been that much worse.