Debate Now An Unhappy Birthday for Obamacare?

[Greenbeard]

I'm pretty sure my argument has been pretty consistent.

You've used consistent rhetoric, but when pushed about what you're actually talking about, the best example you could come up with is that hospital cafeterias and waiting areas aren't as clean as they used to be. (We, of course, have already established that the actual patient care areas in your local hospitals on the other hand have gotten cleaner over the last five years.)

That is what you've presented as the great dismantling of American health care.

Meanwhile, thousands of lives per year are being saved as hospitals implement new patient safety protocols under the ACA.

I have no clue whether either presentation mentioned even addressed the points you and I have been arguing

Just to make sure I'm clear here: the president and the HHS Secretary have been making major speeches on the ACA (which, yes, tout the shift toward value-based payment models and reductions in hospital-acquired conditions) and while you "have no clue" what they've said in them you felt comfortable using "You don't find the HHS secretary or the President or any of their surrogate media pushing those concepts" as critical evidence of your point that the ACA must be terrible? I really don't think it's unreasonable to ask that you at least try to verify the 'facts' used to support an argument before posting them.

If requesting a modicum of intellectual honesty violates the thread rules, I don't really understand the point of having a dedicated debate forum. I had high hopes for a slightly higher caliber of discussion than one gets in the other forums.

 

[Foxfyre]

I'm pretty sure my argument has been pretty consistent.

You've used consistent rhetoric, but when pushed about what you're actually talking about, the best example you could come up with is that hospital cafeterias and waiting areas aren't as clean as they used to be. (We, of course, have already established that the actual patient care areas in your local hospitals on the other hand have gotten cleaner over the last five years.)

That is what you've presented as the great dismantling of American health care.

Meanwhile, thousands of lives per year are being saved as hospitals implement new patient safety protocols under the ACA.

I have no clue whether either presentation mentioned even addressed the points you and I have been arguing

Just to make sure I'm clear here: the president and the HHS Secretary have been making major speeches on the ACA (which, yes, tout the shift toward value-based payment models and reductions in hospital-acquired conditions) and while you "have no clue" what they've said in them you felt comfortable using "You don't find the HHS secretary or the President or any of their surrogate media pushing those concepts" as critical evidence of your point that the ACA must be terrible? I really don't think it's unreasonable to ask that you at least try to verify the 'facts' used to support an argument before posting them.

If requesting a modicum of intellectual honesty violates the thread rules, I don't really understand the point of having a dedicated debate forum. I had high hopes for a slightly higher caliber of discussion than one gets in the other forums.

If requiring me to agree that your sources are superior to my own is your definition of a 'higher caliber of discussion', I'm afraid you will be disappointed. If a 'higher caliber of discussion' is an assumption that if I read the information you provided I would be convinced, I'm afraid you will be disappointed. If a 'higher caliber of discussion' requires other members to verify facts you have presented, I'm afraid you will be disappointed.

But yes, accusing others of intellectual dishonesty or not checking facts just because they disagree with you is a violation of the thread rules.

 

[Sun Devil 92]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

 

[Sun Devil 92]

Are hospitals getting safer? Yes. ("U.S. hospitals make fewer serious errors; 50,000 lives saved")

I'll take your responses one at a time as I have time.

This claim and the associated article don't make any sense.

This is from the article:

In 2010, the HHS inspector general estimated that poor care in hospitals contributed to the deaths of 180,000 patients covered by Medicare, which insures the disabled and those 65 or older, every year.

Really ? Someone wants us to believe that this many people died every year because of "poor care" in hospitals.

That pretty much pales against the Harvard BS study that said 47,000 people a year die because of a lack of health insurance (even though the left could never produce any of the names of the over 500,000 people who should have died since the study was published).

I have to say that if that many people were dying, there should have been a public outcry and someone should have gone to jail.

Bottom line is that I don't buy the claim to be that large.

This came from another article:

Hospitals prevented nearly 15,000 deaths and 560,000 injuries by reducing additional illnesses and infections acquired in the hospital, preliminary data from the Health and Human Services Department show.

Are Hospital Patients Healthier Under Obamacare - NationalJournal.com

If hospitals were really that unsafe (and it would be great to know just what so unsafe), I'd be astounded that someone like Barbara Boxer wasn't using it as a campaign issue.

This just does not pass the smell test.

And BTW: These four hospitals are now really safe:

Fourth Georgia hospital closes due to Obamacare cuts The Daily Caller

All of which goes to show the extreme mischaracterization and hyperbole that results from partisan eagerness to defend even the indefensible.

How many times have we seen it claimed that some in Congress cut or wanted to cut the budget for some presumable 'noble' purposes when in fact all that was proposed or implemented was a smaller increase than was initially requested. The actual budget or spending was not cut at all, but rather increased, just not as much as some wanted it to.

Likewise, I am seeing the same kind of argument applied to Obamacare. They see a factoid that enrollments are more than first thought or that costs for this or that are lower than they were projected to be as a triumph that Obamacare is working. They won't acknowledge that just because the increase in a cost was 25% instead of a projected 30% is not a huge endorsement. The fact that the worse case scenario didn't happen does mean that it wasn't bad.

I am not as willing to slam the door on this one yet.

I was just saying that, at first glance, this one looks fishy.

In the first place the estimates are all over the map.

But more importantly, that means that 180,000/320,000,000 (or 0.05 of one percent) of the total population dies each year because of hospital accidents. Now, if we assume that 10% of the population is in the hospital in any year, that means you have a .5 of one percent or 1 in 200 chance of dying in a hospital.

Look over my math.

If I had a 1 in 200 chance of dying on a plane....I'd never fly again.

Again...check my math.

O.K. Nobody checked the math.

I'll ask again...did I get this wrong ?

 

[Sun Devil 92]

But if it is working so hard to correct problems, why aren't the ACA people shouting that from the rooftops?

...they are.

Better, Smarter, Healthier: Health Care Payment Learning and Action Network kick off to advance value and quality in health care

The Affordable Care Act established an ambitious new framework to move our health care system away from rewarding health providers for the quantity of care they provide and toward rewarding quality. These new models have been put to work in Medicare, and have contributed to 50,000 fewer patient deaths in hospitals due to avoidable harms, such as infections or medication errors, and 150,000 fewer preventable hospital readmissions since 2010, when the Affordable Care Act became law.

Affordable Care Act initiative builds on success of ACOs

The U.S. Department of Health and Human Services today announced a new initiative from the Centers for Medicare & Medicaid Services’ Innovation Center (CMS Innovation Center): the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination, helping to move our health care system to one that achieves the Department’s goals of better care, smarter spending, and healthier people.

Since 2010, 9.4 million people with Medicare have saved over $15 billion on prescription drugs

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

HHS awards more than $665 million to design and test state-led efforts to improve health care quality, accessibility and affordability

Twenty eight states, three territories and the District of Columbia will receive over $665 million in Affordable Care Act funding to design and test health care payment and service delivery models that will improve health care quality and lower costs, Health and Human Services Secretary Sylvia M. Burwell announced today. Together with awards released in early 2013, over half of states (34 states and 3 territories and the District of Columbia), representing nearly two-thirds of the population are participating in efforts to support comprehensive state-based innovation in health system transformation aimed at finding new and innovative ways to improve quality and lower costs.

HHS awards $36.3 million in Affordable Care Act funding to reward and expand quality improvement in health centers

Health and Human Services Secretary Sylvia M. Burwell today announced $36.3 million in Affordable Care Act funding to 1,113 health centers in all 50 states, the District of Columbia, and seven U.S. Territories to recognize health center quality improvement achievements and invest in ongoing quality improvement activities. The health centers receiving awards today are proven leaders in areas such as chronic disease management, preventive care and the use of Electronic Health Records (EHRs) to report quality data.

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

Highlighting the ACA's work to improve patient safety, pay for more effective and higher-quality care, empower states to pursue health reforms and innovations, boost health centers, save on prescription drug costs, etc. And that's just in the past few months (and I skipped the stuff about marketplace enrollment and the millions that are being helped to afford their premiums).

The "I don't pay attention so X must not be happening" argument is getting old pretty quickly.

And even the good stuff that anybody can point to in the ACA does not justify dismantling the entire U.S. healthcare system

Talk about hyperbole.

This is all coming from the HHS.

I'm supposed to trust them and their analysis ?

I mean, really....I don't have an ideological need to say they are lying.

I have a true concern. The same way I would express concern over the Rush Limbaugh/Sean Hannity ies of the world the selective data they present.

As I've said before...finding good information seems real hard. I gave you my math on the 180,000 per year dying in hospitals (and equate it to the bogus Harvard study that was used to sell Obamacare).....no reply. It does not wash. And consequently, I am only more frustrated.

 

[Sun Devil 92]

The fact that the best case scenario didn't happen does not mean that it wasn't good.

That is true. But when a majority of the population perceive it as bad, I don't think we can dismiss that perception just because it is politically incorrect to do so.

When that majority is misinformed...we most certainly can dismiss the perception.

Nobody has shown me any credible evidence from non partisan sources that the majority are misinformed.

Or that the misinformed are the detractors. From what I've seen, the people fighting it know far more about the law, on average, than those supporting it.

That would be BS.

Actually your claim is just as bogus.

Unless someone has a study that shows one way or the other.

 

[Greenbeard]

This is all coming from the HHS.

That's the point. The claim was that HHS isn't touting the law's extremely positive effects (ergo there must not be any!). A fairly easy claim to refute.

As I've said before...finding good information seems real hard. I gave you my math on the 180,000 per year dying in hospitals (and equate it to the bogus Harvard study that was used to sell Obamacare).....no reply. It does not wash. And consequently, I am only more frustrated.

Honestly, I'm not sure what you're finding hard about this. OIG did a medical records review of a representative sample of Medicare beneficiaries admitted to hospitals. Turns out 1.5% experienced an adverse event due to their care that led to their deaths (most commonly medication errors). Many more were hurt by their care but not fatally.

These findings comport with the findings of the Institute of Medicine and other independent reviewers who've examined the question. This should be (but apparently isn't) widely known: hospitals can be dangerous. Many tens of thousands--likely well north of 100K--patients are killed by them every year, many more are otherwise harmed by them. That's been the case forever. This isn't controversial, by the way. The uncomfortable prevalence of preventable medical errors is widely acknowledged.

The good news is that hospitals are getting better, and hospitals around the country are now making a concerted effort to create safer environments.

 

[Sun Devil 92]

This is all coming from the HHS.

That's the point. The claim was that HHS isn't touting the law's extremely positive effects (ergo there must not be any!). A fairly easy claim to refute.

As I've said before...finding good information seems real hard. I gave you my math on the 180,000 per year dying in hospitals (and equate it to the bogus Harvard study that was used to sell Obamacare).....no reply. It does not wash. And consequently, I am only more frustrated.

Honestly, I'm not sure what you're finding hard about this. OIG did a medical records review of a representative sample of Medicare beneficiaries admitted to hospitals. Turns out 1.5% experienced an adverse event due to their care that led to their deaths (most commonly medication errors). Many more were hurt by their care but not fatally.

These findings comport with the findings of the Institute of Medicine and other independent reviewers who've examined the question. This should be (but apparently isn't) widely known: hospitals can be dangerous. Many tens of thousands--likely well north of 100K--patients are killed by them every year, many more are otherwise harmed by them. That's been the case forever. This isn't controversial, by the way. The uncomfortable prevalence of preventable medical errors is widely acknowledged.

The good news is that hospitals are getting better, and hospitals around the country are now making a concerted effort to create safer environments.

I find this post to be somewhat incredible.

But before I speak out of turn, I'd like to ask a few questions.

Didn't medicare include forms of regulations regarding hospital "performance" ?

Were hospitals unregulated prior to the ACA ? I know the answer to that is no.

So the question has to be.....How was this happening under the nose of regulators ?

 

[Foxfyre]

This is all coming from the HHS.

That's the point. The claim was that HHS isn't touting the law's extremely positive effects (ergo there must not be any!). A fairly easy claim to refute.

As I've said before...finding good information seems real hard. I gave you my math on the 180,000 per year dying in hospitals (and equate it to the bogus Harvard study that was used to sell Obamacare).....no reply. It does not wash. And consequently, I am only more frustrated.

Honestly, I'm not sure what you're finding hard about this. OIG did a medical records review of a representative sample of Medicare beneficiaries admitted to hospitals. Turns out 1.5% experienced an adverse event due to their care that led to their deaths (most commonly medication errors). Many more were hurt by their care but not fatally.

These findings comport with the findings of the Institute of Medicine and other independent reviewers who've examined the question. This should be (but apparently isn't) widely known: hospitals can be dangerous. Many tens of thousands--likely well north of 100K--patients are killed by them every year, many more are otherwise harmed by them. That's been the case forever. This isn't controversial, by the way. The uncomfortable prevalence of preventable medical errors is widely acknowledged.

The good news is that hospitals are getting better, and hospitals around the country are now making a concerted effort to create safer environments.

I find this post to be somewhat incredible.

But before I speak out of turn, I'd like to ask a few questions.

Didn't medicare include forms of regulations regarding hospital "performance" ?

Were hospitals unregulated prior to the ACA ? I know the answer to that is no.

So the question has to be.....How was this happening under the nose of regulators ?

That's a very important observation SD. While I would be the first to defend some forms of regulation as valuable and necessary, when government regulation has not produced the desired results or worse, has produced unintended negative consequences, it seems reasonable to think that more regulation is not a fix for that.

 

[Greenbeard]

Didn't medicare include forms of regulations regarding hospital "performance" ?

Were hospitals unregulated prior to the ACA ? I know the answer to that is no.

So the question has to be.....How was this happening under the nose of regulators ?

The government tends to defer to the private professional bodies that shape the standards for the industry. From an excellent perspective on where patient safety in hospitals stood a decade ago:

U.S. health care regulation has been strongly influenced by professionals, in that the government often allows regulatory requirements to be satisfied by adherence to standards established by professional associations, or public and private organizations governed primarily by professionals. For example, hospitals participating in Medicare are required to undergo regulatory review by the Centers for Medicare and Medicaid Services (CMS). Alternatively, through its “deeming authority,” the CMS allows hospitals to participate if they are accredited by a private body approved by the CMS (such as the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO). Private organizations fulfilling this role are sometimes referred to as quasi-regulatory organizations.

Other than that government involvement has largely been limited to encouraging voluntary reporting on medical errors (see the Patient Safety and Quality Improvement Act of 2005).

Starting in 2007, Medicare started requiring hospitals that billed it to include "present on admission" indicators that showed which conditions a patient had when they were admitted to the hospital (to distinguish from those they developed while in the hospital). And starting in 2008, Medicare adopted a policy that if a condition that was not present on admission bumped up a patient's complexity, Medicare would not pay the hospital additional money on account of that added complexity. A nice start and a logical step, but rather weak.

Beyond that, prior to the ACA there was surprisingly little going on. The ACA put financial teeth into it (money, not regulations, to influence behavior), linking reductions in patient harm to a broader shift toward reimbursing hospitals based on how well they do.

The Hospital-Acquired Condition Reduction Program, established by the healthcare reform law, penalizes hospitals that fall within the worst-performing quartile, based on measures of adverse events occurring during hospital stays, such as pressure ulcers, pulmonary embolisms and certain types of healthcare-associated conditions.

The HAC Reduction Program is part of a far-reaching effort that, along with the CMS' value-based purchasing and readmissions reduction programs, aims to aggressively move the federal government toward paying for high performance rather than volume of services.

It also seeded a large system of local Hospital Engagement Networks that brought together thousands of hospitals to collectively work on improving the processes underlying patient safety.

Hospital Engagement Networks participants make big strides in reducing patient harm and readmissions

Lea Regional, which is the only acute care facility in a community of about 75,000 people on the Texas border, instituted the safety moment in 2012, after the organization joined a Hospital Engagement Network operated by the American Hospital Association and the Health Research & Educational Trust. The AHA/HRET HEN is one of 26 nationwide created in December 2011 with $218 million in grants from the Partnership for Patients, a Health & Human Services initiative to improve patient care. The goals are twofold: to reduce patient harm by 40 percent and readmissions by 20 percent over three years.

Hospitals participating in a HEN must meet ambitious goals across 10 categories of harm reduction: adverse drug events; catheter-associated urinary tract infections; central line-associated blood stream infections; patient falls; obstetrical events, including early-elective deliveries; pressure ulcers; preventable readmissions; surgical-site infections; ventilator-associated pneumonia and venous thromboembolism.

The AHA/HRET HEN, which sunsets at the end of 2014, is the largest in the nation and includes 1,500 hospitals and 31 state hospital associations. Through its achievements, it has demonstrated that engaging staff from top to bottom in quality improvement work and participating in shared learning across institutions in a noncompetitive environment can improve care quality.

The results over the past few years have been those already quoted: notable reductions in hospital-acquired conditions (millions of adverse events avoided and billions of dollars saved), not to mention tens of thousands of preventable deaths avoided.

 

[Sun Devil 92]

The results over the past few years have been those already quoted: notable reductions in hospital-acquired conditions (millions of adverse events avoided and billions of dollars saved), not to mention tens of thousands of preventable deaths avoided.

This is amazing to hear.

I can't argue that it isn't the case.

How an industry would be allowed to continue operating like this for so long is beyond me.

The refining industry can't so much as piss in a river and the whole world comes unglued (and have for decades), and this many people are dying or because of hospitals.

I am not going to argue against the influence of Obamacare.

I simply don't see how we needed Obamacare to make this change. Additionally, if Boxer and Co. were so keen to this....did anyone go to jail for any of these deaths. 180,000 a year and nobody is held accountable ?

 

[dblack]

Didn't medicare include forms of regulations regarding hospital "performance" ?

Were hospitals unregulated prior to the ACA ? I know the answer to that is no.

So the question has to be.....How was this happening under the nose of regulators ?

The government tends to defer to the private professional bodies that shape the standards for the industry.

Which is why they passed a law indulging the insurance industry's desire for captive customers.

 

[Sun Devil 92]

Since 2010, 9.4 million people with Medicare have saved over $15 billion on prescription drugs

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

So let's look at this one.

Just what does this mean ?

Somebody else picked up the tab ?

They simply didn't buy as much ?

Pharma cut people a deal ?

The article does not say just how this was accomplished.

And once again, someone has to ask how we had that much fat in the system.

This is one I can believe because I know many seniors spend a lot of time at the doctor simply because they are lonely.

 

[Sun Devil 92]

Didn't medicare include forms of regulations regarding hospital "performance" ?

Were hospitals unregulated prior to the ACA ? I know the answer to that is no.

So the question has to be.....How was this happening under the nose of regulators ?

The government tends to defer to the private professional bodies that shape the standards for the industry.

Which is why they passed a law indulging the insurance industry's desire for captive customers.

Please expand on your statement.

What I am reading is that somehow we let the fox rule the chickencoup. And the professional bodies apparently turned out to be pretty incompetent.

Statistics seem to support some kind of improvement.

Yes, we know that insurance essentially became the profit making middleman....but how does that affect hospital safety ?

 

[candycorn]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

When there are more persons on insurance, they get preventative help and do not wait for an emergency situation. Acute care costs much more than preventative care since we're talking about pills vs. procedures.

Additionally, the insurance allows the public to escape the costs of trauma care and eleviates the stress on the public health system.

 

[Foxfyre]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

When there are more persons on insurance, they get preventative help and do not wait for an emergency situation. Acute care costs much more than preventative care since we're talking about pills vs. procedures.

Additionally, the insurance allows the public to escape the costs of trauma care and eleviates the stress on the public health system.

Not when there are fewer doctors seeing more patients. Not when you can't get an appointment with your doctor when you need to see a doctor now. Most doctor's offices these days have answering machines that tell you that if you are experiencing a medical emergency, dial 911. Otherwise leave a message and your call will be returned within 24 hours or some such.

And the emergency rooms are packed and overflowing everywhere.

And with much higher deductibles, higher copays, and higher premiums for most folks, most people are experiencing significantly higher out of pocket costs.

 

[Sun Devil 92]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

When there are more persons on insurance, they get preventative help and do not wait for an emergency situation. Acute care costs much more than preventative care since we're talking about pills vs. procedures.

Additionally, the insurance allows the public to escape the costs of trauma care and eleviates the stress on the public health system.

If you are suggesting ER visits will go down or have gone down, you'd be wrong.

Obamacare and emergency rooms a bit of perspective needed Center for Public Integrity

On paper the argument sounds plausible, but it does not seem to be happening in reality.

It might be, as the article suggests...that it will take time. There are no guarantees.

BTW: Not much of a case. Just because you say so...does not make it so.

ER Visits Jump As Obamacare Kicks In Doctors Say

http://r.search.yahoo.com/_ylt=A0LE.../545066//RK=0/RS=AKVFqajh9rhPxhCx.fjCqrA3heI-

Obamacare Medicaid Expansion to Worsen Hospital ER Burden - Bloomberg Business

Up to this point, the conventional argument, which has never really been proven was that people without insurance go to the ER to get care because they wait until things get critical. It would seem the case was simply that they found the ER to be a better deal.

Many of these people supposedly had no intention of paying their ER bill and so the costs were pushed out to the rest of those with insurance.

That seems reasonable.

The mechanism for lowering ER visits does not seem to be as simple as giving people insurance. There must be some other steps as well.

 

[Bfgrn]

Note: This thread is in the structured debate zone. If this is your first visit to this forum please review the special rules.

Today, March 23, 2015, is Obamacare's fifth birthday.

Sally Pipes summarizes some realities and perceptions about Obamacare that was signed into law five years ago today and the report card is not good.

I'll play contrarian here by noting that the report card is actually extremely good by almost any measure (which should also cover why I chose the polling option I did).

Almost all of Pipes' points have focused on costs and fiscal consequences, so let's talk about that.

On costs, the news since the ACA passed five years ago has been uniformly good. On the fiscal front, the costs to the federal government/taxpayer have fallen considerably: if you compare spending projections for any consistent time window, the price tag of the law has fallen substantially. For instance, here's the Wall Street Journal just a few weeks ago in Future Obamacare Costs Keep Falling (and if you're wondering about past Obamacare costs, actual FY14 spending on the law was also >30% lower than advertised back in 2010):

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

Of course, it's not just the sinking price tag associated with the ACA.

Overall health spending growth (across the public and the private sectors) each year since the law passed has been hovering at the lowest levels ever recorded. Health care price inflation has also hit unprecedented lows--year-over-year hospital prices actually fell this year, which simply isn't something that happens in the American health care system. Sometimes I forget that this actually has to be pointed out but here goes: this is extraordinary. There's never been a time like this in the American health sector in the past 60 years, other than a short period in the mid-90s--and that one didn't last as long nor go as deep as the current slowdown.

The unexpected and sustained slowdown in health care cost growth has also meant that the savings the ACA counted on (mostly in the Medicare program) haven't just materialized, they've been far bigger than was needed to cover the ACA's new spending--which again, has turned out to be much lower than was advertised anyway.

Pipes says there's no competition, yet premiums in the exchanges basically stayed flat from 2014 going into 2015 because of competition in the exchanges (employer-based premium growth also had a good 2014, tying a record low). And those 2014 exchange premiums were already up to 20% lower than premiums for comparable employer-based plans because of, you guessed it, competition. The reality is that we're seeing more broad and sustained efforts to get a handle on health care costs now than ever before and much of it is driven by competition. And yeah, that's what narrow networks are about--they're a way for insurers to offer lower cost options to cost conscious shoppers, alongside higher cost broad network options.

Meanwhile, we know that the net number of uninsured has already sunk by more than 16 million (and counting) and key indicators of health care quality have been improving, from falling medical errors and preventable readmissions in hospitals to better performance on metrics tracked by the body that accredits hospitals to Medicare Advantage plan performance, and so on.

But stats (as extraordinary and unprecedented as these ones are) are dry and boring and they risk missing the point. For the first time in a long time, health care in the U.S. is changing for the better.

As I mentioned the other day in another thread,

• If you want the case that the ACA's "reforms are empowering patients, driving public and private health insurers to achieve better value, forcing existing providers to shape up and providing opportunities for disruptive newcomers," The Economist presented it a week or so ago.
• PwC also did a deeper dive this week into how the ACA has been transforming American health care in Healthcare reform: Five trends to watch as the Affordable Care Act turns five. They remind us that "In its first five years, the Affordable Care Act (ACA) has had a profound, and likely irreversible, impact on the business of healthcare... By energizing five fundamental shifts over the past five years, the law has given rise to a New Health Economy predicated on value."

Insurers, public and private, are changing the way they pay for services to start paying for health and quality outcomes (presumably what this market is supposed to produce) and not just encouraging the endless churning out of health widgets to generate a revenue stream. Insurers have also had to adapt their business to not just be competitive but useful to their enrollees (particularly those with chronic health conditions). Meanwhile, innovators and start-ups are catering to an increasingly cost-conscious, market-driven consumer base to offer lower cost care options--a trend in line with the increase in price transparency and, yes, those evil deductibles that expose people to prices.

Health care providers are responding by stepping up and tackling the toughest problem of all: maintaining and improving the health of the populations they touch. This is a paradigm shift (one, by the way, that aligns with the simultaneous paradigm shift in the insurance industry, toward determining premiums and designing benefit packages at the community level). This is what's going to hold down cost growth long-term, this is what's going to improve the quality of our care and the health of people long-term.

Biden was correct five years ago: this is a BFD (and it seems to have started bearing some serious fruit unexpectedly quickly). This isn't the same industry it was only five or so years ago--it's better and it keeps improving.

So I'll go with "I mostly support Obamacare in its entirety." The evidence that we're on the right track has been piling up pretty high lately. And contra Sally Pipes, the report card thus far is quite good.

According to those reporting on the latest (2015) numbers from the CBO, here is what Obamacare will cost us:

. . .It will cost the federal government – taxpayers, that is – $50,000 for every person who gets health insurance under the Obamacare law, the Congressional Budget Office revealed on Monday.

The number comes from figures buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook.

The best-case scenario described by the CBO would result in 'between 24 million and 27 million' fewer Americans being uninsured in 2025, compared to the year before the Affordable Care Act took effect.

Pulling that off will cost Uncle Sam about $1.35 trillion – or $50,000 per head. . . .
Politics CBO ObamaCare to cost 50 000 in taxpayer money - per person insured Best of Cain​

And looking at the horrible mess that is being created, the disruption of healthcare of tens of millions of Americans with most paying far more than they had to under the old system, the flight of insurance companies and doctors from a broken system that is a nightmare of inefficiency and red tape. . . .

. . .the fact is we just aren't getting our money's worth and we are getting much worse healthcare than before to boot.

 

[candycorn]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

When there are more persons on insurance, they get preventative help and do not wait for an emergency situation. Acute care costs much more than preventative care since we're talking about pills vs. procedures.

Additionally, the insurance allows the public to escape the costs of trauma care and eleviates the stress on the public health system.

Not when there are fewer doctors seeing more patients. Not when you can't get an appointment with your doctor when you need to see a doctor now. Most doctor's offices these days have answering machines that tell you that if you are experiencing a medical emergency, dial 911. Otherwise leave a message and your call will be returned within 24 hours or some such.

I have seen five different physicians in the last calendar year. No problem getting any of the appointments.

[
And the emergency rooms are packed and overflowing everywhere.

Tragic...

And with much higher deductibles, higher copays, and higher premiums for most folks, most people are experiencing significantly higher out of pocket costs.

Beforehand people showed up at the County hospital and the taxpayers were liable for 100% of the costs. Now, gee, the individual pays. I like sending less of my tax dollars down that particular drain.

 

[candycorn]

More people being insured is better than fewer. The ACA has facilitated that. Does it have some problems? Sure. Every program ever launched does and, as far as I know, no program ever launched was perfect right out of the gate.

And why is that ?

Please make the case and don't call it self-evident.

When there are more persons on insurance, they get preventative help and do not wait for an emergency situation. Acute care costs much more than preventative care since we're talking about pills vs. procedures.

Additionally, the insurance allows the public to escape the costs of trauma care and eleviates the stress on the public health system.

If you are suggesting ER visits will go down or have gone down, you'd be wrong.

Obamacare and emergency rooms a bit of perspective needed Center for Public Integrity

On paper the argument sounds plausible, but it does not seem to be happening in reality.

It might be, as the article suggests...that it will take time. There are no guarantees.

But here we are , 2 years in pronouncing it a failure. And I am certain that there are more ER visits. In the past, if you were sick and had no insurance, you go to the County hospital and the taxpayers pay 100% of the costs.

Now that Jane Doe is paying for a product each month (or paying the tax penalty), they are using it by showing up at the hospitals in and around their home.

I have no doubt it will take some time and modifications.