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ACA Fail Fractal
Romneycare Fail is Bad News for ACA
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  • Andrew Allison

    TAI has reported in the past on the increase in hospitalization under ACA and expanded Medicaid due, presumably, to the cost and availability of primary care. What’s lacking is useful information. For example, what is the “rate of of unnecessary hospitalizations” referred to and does it take into account the 25% increase in Medicaid and CHIP enrollment resulting from ACA and the number of previously uninsured who now have private insurance? The costs to the patient of Medicaid and privately-insured primary care? Etc.

  • rheddles

    lowering costs must always come first.

    Then expand supply or lower demand. Insurance certainly doesn’t lower demand. Of all the prescriptions offered only empowering nurse practitioners might expand supply. There is much more opportunity through lowering demand by placing more of the cost burden on the consumer and making prices more transparent.

    • FriendlyGoat

      “and making prices more transparent” is the missing piece we have been waiting for since the 1970’s.

    • f1b0nacc1

      Transparency cannot make a difference as long as the end-consumer of health care isn’t the person paying for it. After all, the insurance companies already KNOW what they are paying, and they do business with providers accordingly. If individuals actually receiving the healthcare were paying for it (i.e. ‘skin in the game’) then they would demand more information and pricing transparency would emerge. Actually our resident statist himself gave the example of how the private world does it with the Kelly Blue Book and auto pricing.
      On the subject of nurse practitioners, I couldn’t agree with you more. Loosening the idiotic restrictions on licensing in general would be a huge help as well, we are long past the time where it would be a good idea to take a long, long look at that.

      • rheddles

        I agree wrt skin in the game. That’s why I used the conjunction and.

  • qet

    Pretty much every piece, in TAI and elsewhere, that discusses this subject focuses solely on economic factors. Those are nice, clean, measurable, modelable things that appeal to foundations, think tanks and university departments staffed with grad students, statisticians and Econ and Poli Sci PhDs. But it is more probable that non-economic factors are the causes of the vast bulk of these results. The WaPo piece alludes to a few possible such causes, but only briefly and in passing as though it is uncomfortable (which it is) with the implications. It has been documented time and again that low-income persons fail (more than higher-income persons) to take their prescribed pharmaceuticals properly, timely and completely. And this is just a matter of opening a pill bottle and swallowing a pill. To expect such persons to be able to accommodate themselves suddenly, once they have “insurance,” to a regimen of primary care visits, specialist visits and regular follow-up visits in order to manage medical conditions outside of a hospital is probably unrealistic. Heck, plenty of “educated,” middle class types behave in the same way, waiting until a condition becomes acutely critical before seeking treatment. As anyone who has had a chronic condition knows, going to the doctor’s office with any degree of frequency is an unbelievable pain in the backside. It must be managed within the context of a real, lived life; it requires effort and perseverance; and many folks just are not going to make the effort until the problem is acute. It is just too easy to model all of this in terms of costs and imagine that tweaking this cost factor over here and that cost factor over there will produce statistical result X across the population. That’s what the models say, after all. So Romneycare and Obamacare can fail for reasons having nothing to do with economics. In other words, if you build it, they still probably won’t come.

    • FriendlyGoat

      You make a valid point. But I hope no one interprets that to mean we shouldn’t bother to “build it”.

      • qet

        We have already built “it.” A better metaphor here for that “it” than a baseball diamond, whence the phrase came, is a house. We keep building it–building onto the house, adding new rooms. Those rooms remain unoccupied or underoccupied, but the only solution urged is to build still more rooms. We need to stop wasting the money building new rooms and instead devote our efforts to filling the rooms we have already built. But the media, commentariat and punditocracy in this country do not credit politicians, governments or private institutions with having done something about something unless it involves spending more money than was spent before. It matters little how the money is actually spent/wasted.

        • FriendlyGoat

          Taking “medical underwriting” out of the health insurance game is an incredibly-important new “room” we have built, and one which I “think” the public will now refuse to allow Republicans to demolish. We can only wait and see.

          • qet

            Yes, but like everything else about Romneycare and ACA, it is important only symbolically. I agree with your prediction vis-a-vis the public’s likely behavior, but again, what they will refuse to see demolished is a symbol only.

            All of the analyses of Romneycare and ACA, some even from left-leaning sources, uniformly describe the near-utter failure of the programs to actually work on the level they were sold on as working: making health care “affordable.” It is not only no more, it is less affordable now than it has ever been, and in the last 5 years that trend has been largely traceable to the actual real world effects of the ACA. Even left-inclined publications are publishing frequent laments and regrets of erstwhile believers now trapped in the quicksand of Obamacare’s actual administrative and economic reality. The only “win” that the President’s loyal acolytes can point to is that a lot of people who did not “have insurance” before now “have” it. But so what? This TAI piece we are discussing is just the latest evidence that “having insurance” does not translate to anything except “having insurance.” That is, it is a symbolic achievement only. It is a matter of definition, tautological. The ACA has conferred the symbolic status of “having insurance” on a whole bunch of people, therefore it has done what it set out to do.

            This is how the entire debate has been going on. This is why I complained that the people who you’d naturally think to be all over the analysis of the mechanics of the thing in operation–the policy wonks–won’t come near it. Instead, they just keep repeating: “Under ACA X more people have insurance; therefore ACA is a success.” It happens everywhere. If you oppose the “Lily Ledbetter Equal Pay Act,” you are QED against the very idea of equal pay for women. No supporter will hear you out when you describe the non-necessity of the bill, or of the likely adverse effects it can reasonably be predicted to have. No–any opposition to the law is, given it’s title, opposition to the idea symbolized by the title.

            So that’s what is going on with Romneycare/ACA. Even as the economic and administrative failures mount, as was predicted, the public gets more and more attached to the symbol. And the real pushers of these failures onto society, every time another failure is logged, simply demand more of the same symbols.

          • FriendlyGoat

            Unfortunately, the main alternative suggested from the right has been the idea of “selling UNSPECIFIED health insurance products across state lines”. They do throw in a few other minor ideas, but that one is always the centerpiece.

            I have not yet met anyone who seems to understand that really means 1) Repealing federal policy standards, 2) The federal government then forcing 49 states to abandon their own policy standards down to whatever 50th state with the lowest standards—-from which insurance can then be written. It is nothing but a race to the bottom for consumers.

            This inevitable result of “across state lines” is never discussed in public. Before we hear even another single word from the political right about health insurance, we need THAT particular buzz-phrase dissected in the light of day. It’s “The Plan” and everyone needs to know the fast-mumbled words about “introducing competition” are a cloud of smoke. (VERY DANGEROUS smoke for the financial health of everyone in the lower half of the country.)

  • Jacksonian_Libertarian

    Surprise, Surprise, Socialism doesn’t work, who’d a thought it.

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