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Delivering Health
The ACA Is a Distraction from Our Health Care Crisis

Four years after Obamacare became law, the U.S. still took last place in an annual survey of health care systems in industrialized nations. The Commonwealth Fund, a health care think tank, found that the U.S. is overpaying for poor quality, as WaPo reports:

Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system. […]

The data for the 2014 report was collected before the Affordable Care Act (aka Obamacare) went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them.

This cannot be repeated often enough: Even if you think Obamacare is both a good law and a successful one (an uncertain claim on its own), the truth is that it leaves intact almost of all the major structural problems that make our health care expensive and subpar. The debate over the biggest health care law in recent history has therefore been almost entirely irrelevant to the problems actually plaguing our system.

We have a few quibbles with the Commonwealth report, however. For example, healthcare is more expensive in the U.S. than in other countries in part because we invent a lot of new drugs and equipment that benefit the rest of the world while sparing it the costs of research and development. But even with all necessary qualifications, Commonwealth is right to draw attention to the persistent structural problems we face. It’s time for reform, and here’s what we should do first: Lower costs by expanding the number of care providers while working toward re-inventing the delivery of care.

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  • qet

    There is just something fundamentally implausible about a report that ranks the UK no. 1 in so many categories, and that uses such categories as “healthy lives.” Yes, US HC is fractured and inefficient, just like most things here. That is a byproduct of freedom. And the health care “system” keeps expanding to encompass more and more elements, so that soon the set Health Care System will be identical to the set Society. In other words, Health Care System will become, if it hasn’t already, an empty category.
    The only thing missing from this report is an Ezra Klein-like apotheosis of the VA as the model health care system.

    • Andrew Allison

      You probably also believe in AGW, another religion which finds implausible, if not heretical, any actual data which calls into question its dogma. Fact: outcomes are better in all industrialized nations. Fact: those outcomes are achieved at about half the cost of the inferior ones achieved in the US. Fact: the majority of people served by such systems are happy with them. You also probably don’t accept that not all such system are single-provider, as opposed to single-payer. The US healthcare system is a disgrace.

      • qet

        Your choice of words is interesting. You refer to a “belief” in something that is held by many not to be a matter for belief at all. In fact, since you brought it up, I am highly skeptical of the science that is said to be settled on this score. It is my view that the alarmists are engaging in the same belief behavior that they claim their opponents to be. On the health care system metrics, I am equally dubious of the facticity that you so vehemently insist upon. You burn with the passion of faith in this matter, it seems.

        • Andrew Allison

          The facts are clear, you choose not to believe them, I rest my case.

          • qet

            Yes, well, you may be right. But I think you ought to keep in mind something Bertrand Russell once said. He said that “it is characteristic of the advance of science that less and less is found to be datum, and more and more is found to be inference.” These facts you are so certain of are mostly constructs of inference. Maybe correct inference, maybe not, but inference all the same.

          • Andy Arends

            QET, great point. Which is why one should actually look at the data being used to measure outcomes. See this very interesting monograph from NIH, which points out many of the challenges in these so-called objective comparisons. You can also find more research from AEI, a pro-market think tank. In both peer-reviewed sources, it is clear that while you can look at facts, the definitions matter as much (if not more) than the data points themselves. This is not to distract from the fact that the US health care system is sub optimal. But Commonwealth and those that share its agenda do us no favors by obscuring the reality of the system’s pros and cons in the name of spurring us to action.

  • Boritz

    “The debate over the biggest health care law in recent history has therefore been almost entirely irrelevant to the problems actually plaguing our system.”

    A number of commenters on the Far Right have said all along that this is about control, not health care. That would explain the ‘irrelevant’ part.

    • Andrew Allison

      I think the point is that ACA is entirely irrelevant to problems plaguing US healthcare.

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