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ACA Agonistes
A Bird's Eye View of the ACA

Unsatisfied by the poor quality of the conversation about the Affordable Care Act, AI board member Tyler Cowen lays out five metrics that we should use to analyze its progress. A taste:

3. Given that prices in the individual insurance market already seem to have gone up 14-28 percent, and may go up more once political scrutiny of insurance companies lessens, what is the overall individual welfare calculation from this policy change?  I mean using actual economic policy analysis, of the CBA sort, not just noting that more people have health insurance.

4. Given supply side constraints, how much did ACA increase the consumption of health services in the United States?  (I take the near-universal bafflement over the first quarter gdp revision a sign of how poorly we understand what is going on.)  And how good or bad a thing is the ongoing but accelerated shift to narrow provider networks?

Ross Douthat wrote a similar post in April with a different list of three standards, which we also recommend. There is a lot of overlap between Cowen’s five and Douthat’s three metrics, as well as some differences, but these sorts of lists are sorely needed to ground the debate over the ACA. When the ACA was front and center of the national conversation, both sides shifted the grounds of the debate to frame each new event as evidence of the ACA’s success or failure. Both sides would declare victory because one or another metric seemed to be going their way, without taking a more comprehensive perspective.

The ACA debate is bound to flare up again at some point, if only during the next presidential election. When it does, lists like Cowen’s will be incredibly helpful in focusing the debate around a stable set of metrics.

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  • Boritz

    “…lists like Cowen’s will be incredibly helpful in focusing the debate around a stable set of metrics.”

    Add the number of people who won’t be exposed to data and the number who don’t care what the data says and you have an electoral majority, but it was a nice idea that would have had some appeal for an earlier generation.

  • qet

    No list of metrics is going to do any grounding of any debate. The metrics we have already show that the subsidies necessary to pay for people’s ACA-acquired insurance are busy entrenching themselves as just another entitlement program and that the cost curve will be “bent” only by government curtailment of allowed providers and services. The complexity of the ACA ensures that at no time will the Left not be able to trot out a mouthpiece like Krugman or his ilk to claim how successful the ACA has been. The ACA is designed so that its true effects will be unknowable according to the standards of low-IQ obviousness that would sway even liberals to acknowledge what a disaster it is and will be.

  • FriendlyGoat

    The Republicans since 2009 have recommended nothing whatsoever but mumbled phrases about (unspecified) tort reforms and a wish to sell (unspecified) insurance across state lines. The only debate worth having about the ACA is with those who offer better ideas——fleshed out with detail.

    Everything else is fruitless bitching.

    • qet

      That’s because there is no better idea. And that is because this problem is not a problem of ideas. It is a problem of simple arithmetic. Prices are a function of supply and demand, and the supply is relatively inelastic to the demand. There are high barriers to entry on the supply side. All the Econ 101 things you know and a bunch of Econ 102 things as well. So there are only two options. (1) treat it like social security and pay people a fixed amount, an amount we can afford. it may not cover all of their medical costs, like social security may not cover all of your living expenses. But hey, it’s something, right? (2) practice what you preach. Right now the Left is preaching health care uber alles. So prioritize it. Draw in funds from all the other federal spending programs. Reduce Medicare spending and even social security spending to fund ACA payments. Reduce military spending. Get rid of the Dept. of Education and stop all education payments. And so on. The money is there, if health care is really the priority people say it is. But of course that will never happen. Only about 10 people in this country would support the ACA if told that the money to pay for it would have to be reallocated from other spending programs.

      There is a third option. Gather every aspect of health care under federal government operation and control. Then put out propaganda, I mean data, that proves that our health care is now the best ever in the entire history of the universe. Krugman, Klein & Co. can be counted on to mindlessly propagate the message. If we all believe we have a great health care system, then we do have a great health care system. Q.E.D.

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