The single payer pivot is going gangbusters over at the New York Times. The Grey Lady had two pieces out yesterday on health care prices, and the mix of the two shows a paper, and an intelligentsia, deeply confused about health care. In the first piece, “The Cost of Health Care is Seen as Decreasing,” Annie Lowrey reports that despite its troubled launch, the Affordable Care Act is getting at least one thing right: it is costing US taxpayers much less than initially expected.But, as Lowrey goes on to relate, the savings have very little to do with the Affordable Care Act itself. The ACA is merely a passive beneficiary of trends that are effecting health care spending across the board:
Administration officials have pointed to falling hospital readmission rates as one strong sign that cost-control provisions in the Affordable Care Act are working. Also, they noted that a growing number of insurers and health care providers are agreeing to contracts that pay for the quality of care, rather than the quantity, another indication that the law’s encouragement on that front is starting to pay dividends.But those are responsible for only a tiny portion of the slowing rise of health care costs; other changes, like rising deductibles and copays that discourage some people from seeking extra services, play a bigger role, analysts say. Still, the Kaiser Family Foundation, a nonprofit research group, estimates that the weak economy accounts for as much as three-quarters of the slowdown in the growth of spending on health care.
The piece was clearly an attempt to put a positive face on an embattled law, but it does so in a bizarre way, by referencing a health care spending slowdown that all experts agree the ACA did not really cause.But as convoluted as that first piece was, reading it alongside the special feature the Times ran on “soaring” hospital prices is enough to give anyone whiplash. “As Hospital Prices Soar, a Single Stitch Tops $500,” by Elizabeth Rosenthal, argues that for many consumers, health care is getting more expensive, as out-of-control medical inflation and price opacity continue to savage our medical system. The piece contains mostly old news, rehashing many of the (very valid and important) points elaborated on by Stephen Brill in his groundbreaking Time Magazine piece. But the Rosenthal piece is important for the role it’s playing in the delicate two-step single payer pivot that we’ll increasingly see from the left. You can see what’s really going on here with this one line:
The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.
That sentence is the fulcrum point of the single payer pivot. Step one is to argue that the ACA was a success on some access or cost metrics—in the Lowrey piece, that its helping to bring down prices. Step two is to argue that despite its success, the ACA didn’t manage universal coverage or systematic cost controls (because it didn’t attempt it), and therefore we need an ACA 2.0 to build on and expand the successes of ACA 1.0. And, lo and behold, ACA 2.0 looks very similar to a single-payer system.But this narrative is fundamentally confused. As Lowrey herself admits, the ACA wasn’t the driving cause behind cost reductions, and whether the law will be a success on other metrics still very much remains to be seen. Given ongoing stories of network restrictions, we’re skeptical. But the even more fatal error is the belief that health care in America is expensive simply because we don’t have cost controls and if we could just pass federally mandated rate setting, soaring prices could be kept down. A key fact that argument misses is that even in those countries that had price controls, the cost of care is still going up every year.A certain kind of health care wonk sees out-of-control prices and wants to regulate the already heavily-regulated health care sector even more. But the answer to our health care crisis is not more and more federal tinkering in the system; it’s opening up the system to consumer pressure and price transparency, while at the same time innovating new cost-saving ways of delivering care to patients. If we do those two things, any subsequent reform—say, expanding access even more—will get easier. But if we fail on those, the complexity of our system, the structural defects bankrupting us, and the aging of the boomers will limit the successes any top-down reform could achieve.