It’s been a rough few days for the ACA. The CBO’s report put Obamacare’s effects on workforce participation (hint: they’re not good) front and center, and a slew of bad news followed suit. Both the Wall Street Journal and the LA Times covered different aspects the shrinkage of provider networks—the strategy that lies at the heart of health insurers’ plans to control costs under the ACA. The LA Times piece reports on Californians’ struggles to find in-network specialists, while the WSJ article suggests federal regulators are looking to force insurers to expand their networks. More reports are coming in that the initial enrollment numbers reported by the administration were inflated—in this case only 1-2 million of the 6.3 million new Medicaid signups were attributable to the ACA. Finally, Brookings released a report stating that Obamacare will increase incomes of the bottom fifth of Americans, but only by decreasing the incomes of everyone else.In light of all this news it’s easy to get drawn into an anti-ACA feeding frenzy, but an excellent column by Charles Krauthammer in WaPo yesterday explains why there are bigger problems with our health care system, and why technocratic planning of any ideological variety is problematic:
After “first, do no harm,” medicine’s second great motto should be “above all, humility.” Even the tried-and-true may not be true. Take the average adult temperature. Everyone knows it’s 98.6 . Except that when some enterprising researchers actually did the measurements — rather than rely on the original 19th-century German study — they found that it’s actually 98.2.But if that’s how dicey biological “facts” can be, imagine how much more problematic are the handed-down verities about the workings of our staggeringly complex health-care system.
Krauthammer then goes through three recent cases in which “conventional wisdom,” allied to top-down planning, has created big messes: subsidies for electronic health records, assumptions that expanding insurance access would reduce emergency room use, and the belief that having insurance improves health outcomes. All three of these “truths” turn out to be wrong or mistaken.This, in turn, points to a central fact: Health care is a dynamic and unpredictable field that’s very hard to manage from the top. The basic impulse behind much health care wonkery—that we can fix our system by tweaking this or that federal policy—is incorrect and continues to do harm whenever it is acted upon. All the while costs continue to go up, networks continue to narrow, and more and more people—even the insured—are being threatened with financial insolvency because of high medical bills.That doesn’t mean there isn’t any role for policy in health care, but it has to be focused on opening up spaces for innovation and consumer control, not on bureaucratic tinkering. What health care policy needs to be doing is looking toward tomorrow’s innovations, not freezing today’s status quo into law. Things like reforming service delivery, price transparency, and technological innovation are all key priorities. The way forward for health reform is not through sclerotic federal control but in helping to create a dynamic, open market.