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ACA Revisionism
The Grey Lady Punctures Obamacare Myth

It’s amazing what the Obamacare rollout has done to the debate over the law: The once-popular argument that we can cut costs by expanding access is collapsing. At the NYT‘s Upshot, Aaron Carroll notes that in prevention, emergency care, and invasive procedures, expanding access to insurance makes health care more expensive, not less:

Researchers in Michigan compared the prevalence of surgery in Massachusetts, New Jersey and New York both before and after Massachusetts went to universal insurance in 2007. They found that expanding coverage was associated with a more than 9 percent increase in discretionary operations and a 4.5 percent increase in nondiscretionary ones. They estimated, based on their results, that the A.C.A. could lead to more than 465,000 additional discretionary surgical procedures within a few years from now.

Finally, it is a common misconception that prevention always saves money. It is true that there are certain interventions that are cost-saving, such as childhood immunizations and newborn screening. But these are relatively rare. A review of preventive measures in the New England Journal of Medicine found that less than 20 percent of 279 preventive measures saved money. The rest resulted in varying amounts of increased spending.

We’re glad the NYT is putting these points before the public. If the liberal press had been more willing to engage with ideas like this during the 2010 Obamacare debate, we might have come away with a better and more sustainable system. As it is, ugly struggles and hard choices loom ahead. Health care costs seem locked onto a course that will reduce quality and limit access for millions of people, with Obamacare being a net drag on the system.

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  • qet

    We did hear it 4 years ago, and long before then. Just not from the NYT, apparently. Until we solve our political epistemology problem, where significant swaths of the policy-making, -influencing and -commenting elites continue to believe that it’s not a fact or a truth unless and until the NYT says it is, we will continue to ruin ourselves by more ACAs.

    • Boritz

      ” Until we solve our political epistemology problem…”

      And people need to figure out when they’re being lied to and what’s real and what’s phoney.

  • Boritz

    Chevy Chase was much more frank with his admission – years later, of course – that through his Gerald Ford skits he was intentionally trying to harm the image of Ford and the Republicans. &nbspThe clown was more honest than the paper of record will ever be.

  • nyp

    Why is it that healthcare spending rates have decreased so dramatically since ObamaCare was first implemented?

  • nyp

    And it is ironic that on the day this post appeared the New York Times ran the following item:
    “The growth of federal spending on health care will continue to decline as a proportion of the overall economy in the coming decades, in part because of cost controls mandated by President Obama’s health care law, the nonpartisan Congressional Budget Office said on Tuesday.”

    • qet

      Yeah, ironic is one word for it. The same article says, way down in its bowels long after most liberals stopped reading it: “Despite the improvement, federal health care spending is still projected to grow faster than any other budget category as baby boomers retire and begin drawing from Medicare. Health care is on track to become the government’s biggest expense by around 2030.”

      Doesn’t sound so great when you put it like that, does it? Good thing it’s buried deep. Oh, and then there’s this, from the same article, even further down: “Budget office officials acknowledge that any long-term forecast of government spending is tricky because of changes in the economy or federal law that cannot be anticipated. For example, health care spending growth was in line with G.D.P. during the 1990s economic boom, when there were budget surpluses. But forecasters at the time could not have predicted the political and economic changes that would result from the terrorist attacks of Sept. 11, 2001, or the depth of the most recent recession.”

      Meaning: the forecasts are utterly useless. But because they appear to be not unfavorable to the ACA, of course they receive lede treatment and the left will argue that the lede and the lede alone is the “fact.”

      Finally–reducing spending by price controls. Is that really the success the ACA backers want to trumpet?

      • nyp

        I read the full article, and I am well-acquainted with the cost projections. No supporter of health reform has ever asserted that the program would cause net healthcare spending to decrease over the next thirty years. That would be impossible, given, among other things, the natural aging of the population. What people like Peter Orzag did argue, however, was that the myriad of cost-saving proposal in the ACA would contribute to bending the cost-curve downwards, and that it would do so in a significant way. That is precisely what appears to have happened in the early years of the program, even though opponents of the ACA projected the opposite.

        Because the record to date contradicts what conservatives originally projected, you ignore the record to date, and argue instead merely that long-term forcasts are inherently unreliable. If that is the case, why would you accept forcasts that the ACA would result in increases in the long-term rate of growth.

        PS: with respect to “price controls,” what is objectionable about a purchaser of services setting a limit on what he is willing to pay a provider of services?

    • Jmaci

      On ACA cost savings…WRM also posted this recent item indicating that the CBO has given up trying to estimate the cost of Obamacare in part because of the tinkering by President Obama.

      In other words the NYT report you cite should be greeted with some skepticism.

      • nyp

        I am all for skepticism. But the latest CBO unambiguously attributes a portion of the recent massive slowdown in the rate of healthcare spending to the cost-control effect of the ACA. That isn’t a forecast. It is a retrospective examination. And Mr. Mead ignores it entirely.

    • Breif2

      “The growth of federal spending on health care will continue to decline as a proportion of the overall economy”

      It would be nice if the NYT were able to write a coherent sentence.

  • FriendlyGoat

    DESCRIBE the tenets of your imagined “better and more sustainable system” please. If you can’t think of anything but (unspecified) “tort reforms” and selling (unspecified) insurance products “across state lines”, you bought the Republicans pet parrot and have him sitting on your desk.

    • Loader2000

      Here is a concrete plan:

      First, do exactly what you said, forced publicity of all retail prices
      Second: Specifically remove the option of awarding damages for pain an suffering in any mal-practice cases where the practitioner had the proper credentials and was not intoxicated.
      Third: Remove barriers to competition across state lines
      Fourth: Remove the Obamacare mandate for anything but high deductable plans
      Fifth: Remove any subsidies or tax credits for companies providing discount health care to employees. Take that money and put it into a health account for each citizen. They keep what is left at the end of the year.
      Sixth: Reduce regulatory roadblocks or hurdles that make it more difficult for small clinics to operate as opposed to large networks (if such regulatory hurdles exist, and I’m sure they do in some states).

  • Jmaci

    qet and others are right. A lot of nformation about rising costs in Mass. and ineffective preventative care regimens was available before the ACA was passed. Problem is, that information was put forth by conservatives and thus unworthy of consideration.

    • nyp

      “Ineffective preventative care regimens”?? Why do you oppose preventative care?

      • vepxistqaosani

        Because it doesn’t work. See the debates over prostate and breast and colon cancer screening and compare them with the actual data (if you have access to them) from, e.g., the Cochrane Collaboration.

        • nyp

          that there is debate over the efficacy of certain screening programs for certain medical conditions does not mean that preventative medical care in general is either ineffective or cost-inefficient.

      • Jmaci

        I’m not opposed to preventive care. But the item cited by WRM cites a study showing preventative care doesn’t save money. That was reported before the ACA was passed. Here’s the study cited by the NYT.

        • nyp

          Whether checking people out for high cholesterol or pre-cancerous polyps actually saves money is a legitimate issue, and worth of debate. I am not qualified to render an opinion. But it is important to note that the cost and savings projections for the ACA expressly exclude any economic benefit from increased access to preventative care.

  • GodisanAmerican

    The same Grey lady has tons of articles on why Obamacare fails to fail.
    The same Obamacare that is based on romneycare and ideas of which (like individual mandate) begin Heritage Foundation think tank.
    Obamacare is here to stay no matter how much some right-wingers rant about moochers getting healthcare.

    • Breif2

      Obamacare might well be here to stay,
      But what it is changes from day to day.

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