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.