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Reforming Delivery
Looking Beneath the Coverage

The Obama Administration appears to have reached its goal of getting 9.1 million people covered by the end of this year’s open enrollment period. According to the NYT, in fact, 9.5 million have already signed up for coverage for 2015. The story, however, contains its own caveats:

But in 2014, more than 15 percent of people who selected health plans in the public marketplaces failed to pay their share of premiums and were therefore not on the rolls at the end of the year. Officials said they thought that similar attrition could occur this year […]

But federal officials have a long way to go to meet projections by the Congressional Budget Office, which said on Monday that the number of people in the exchanges would rise to 12 million this year, 21 million in 2016 and 25 million for each of the three years after that.

In addition to those two, there is a third factor that needs to be considered: how coverage actually works for people. Wonks and bureaucrats take a technocratic perspective to health care where official uninsured rates become the primary metric for judging success or failure. But one of the most important thing to do when talking about how well our health care system is working is to adopt the consumer perspective. What are a person’s interactions with our medical system actually like? How much access does his or her coverage get him or her? How much does the coverage cost, either through lost wages or out-of-pocket costs? How efficient is the process? Whether people are “covered” or not doesn’t really answer these questions.

Too few participants in our health care debate asks these questions, in part because such matters cannot be reduced to the easy facts or figures that policy makers need. But the gap between the figures and the reality of the consumer perspective means that things can be troubling on the ground even if they look rosy in the official charts and spreadsheets. Until health care wonks internalize that fact, it will be hard for us to prioritize the best kinds of reforms.

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  • Gerald

    One might question whether “wonks” and the top down central planning they advocate is really a practical idea. It hasn’t worked for simpler systems than health care, and there has never been any reason to think that it will work now. There are just too many unintended consequences of presumably well intentioned dictates to have any possibility of working effectively. Expanded insurance coverage could have been handled for people who desired it without wrecking the entire medical care system, but central government control seems to be the only answer that the “wonks” desire.

  • FriendlyGoat

    Everything about this can be evaluated with facts and figures if you assemble data which already exists in secret rabbit holes. We could know, for instance, which holders of each insurance policy saw which providers, what diagnostic codes were involved, what procedures were performed, what medications were prescribed, how much was charged at retail for each item, how much was paid by insurance for each item, how many deductibles were met, what co-pays were paid, how many people “lost” how much on their insurance including deductibles and copays, how many people “gained” how much on their insurance including benefits paid over and above deductibles and copays, how many bills from providers went uncollected and by how much——and ALL of that without disclosing names.

    Why aren’t you asking the Republican Congress of the present or any Democratic Congress of the past to gather the data—-seeing as how it all exists and would most certainly “inform” our policy-making if assembled into coherence?

  • wigwag

    Our nationwide experiment with Romneycare seems to be working out reasonably well yet the best criticism Via Meadia can summon up is that it’s not a panacea. It’s an intellectually bankrupt position and if Walter Russell Mead doesn’t know it, he should. Our health care system still needs massive reform in the worst way and the new system invented by Mitt Romney and championed by President Obama hasn’t solved every problem. Like any massive policy shift it has produced both winners and losers. But over all, there is enough data in to conclude that on balance, the new system is superior to what came before. Face it, Professor Mead; Governor Romney and President Obama have been proven right; you and the other critics have been proven wrong, Via Meadia’s argument that Romney/Obamacare is not a success because not every problem in American health care has been solved, just makes you look ridiculous.

    • Boritz

      ” Like any massive policy shift it has produced both winners and losers.”

      When president Cruz builds a massive fence on the border (with VP Palin cutting the ribbon), abolishes welfare for 80% of those now on it, shifts huge sums from entitlements to the Pentagon, greatly deregulates energy and other industries and goes after Roe v Wade just remember this principle.

  • Kevin

    Instead of access or other intermediate metrics they should be looking at output – are people healthier or not and at what cost? The rest is useless process issues. More people seeing doctors, taking more drugs and having morning procedures done at massively greater cost is not success unless their health actually improves because of this – otherwise we’ve just wasted everyone’s time and money to no effect (or worse).

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