-The ACA was a bad compromise in my opinion. It set up a very complex system for getting people insurance, but did almost nothing to address costs which is what most folks have been complaining about.
I've seen variations of this statement a number of times in the last few weeks. It is worth addressing in detail, I don't have time right now and this perhaps isn't the right thread for to really drill down, but briefly...
...Most people are surprised to learn that about 3/4 of the ACA had nothing to do with insurance, it was cost control measures for Medicare. These cost control measures have been wildly successful, beyond what any reasonable person would have hoped for when the ACA was passed. I'll say it again: Most of the ACA was cost control measures, and the cost control measures have been wildly successful.
The estimate for total federal spending on medical care by 2020 is now $175 billion per year lower than than same estimate made in 2010. Let that sink in for a second.
http://crfb.org/blogs/900-billion-slowdown-federal-health-care-spendingA $175 billion is on the order of the Air Force budget. Saved, per year. That is a metric boatload of money. And when was the last a big government program not only cost
less than expected, but a lot less? And it is even better than that. Sara Kliff notes that the Medicare population estimate also grew by 700,000, so we're actually covering more people for less money than projected. Covering more people for less money is a grand slam, no matter how you figure it. And if you look at all the costs, private insurance, medicare, medicare, since the ACA came into effect in 2014 the total savings to the public are the on the order of trillions of dollars. Yes, trillions with a "t" Hey, a trillion here, a trillion there, pretty soon you are talking about real money.
http://www.vox.com/2016/6/21/11981610/health-spending-slowdown-obamacareWe've had a lot of discussions about Medicare and Social Security lately. The ACA extended Medicare's solvency by 13 years. Prior to the ACA Medicare was projected to have a shortfall right about now, 2016-18, something like that. Which means Obama saved all of us a tax hike, right about now.
And the news is even better than that. A lot of the changes to Medicare have been designed to provide better care. It is no secret that medical care in the US lags the performance of other industrial countries. But where the US is particularly bad compared to other countries is in areas like hospital acquired infections, doctor mistakes, duplicate tests, and hospital readmissions. Those areas are really the low hanging-fruit for cost control. Preventing an infection is lot cheaper than acquiring one. Duplicate tests cost twice as much as a single test. On and on. Better care is very often cheaper care.
The ACA provided Medicare with a number of subtle carrots and sticks to address those issues. The results have been great! Tens of thousands of lives and tens of billion of dollars have been saved, while improving outcomes. That's a home run too.
https://www.washingtonpost.com/news/to-your-health/wp/2015/12/01/hhs-says-patient-safety-efforts-have-saved-87000-lives-20-billion/The same types of performance improvements and cost savings have been seem in other areas like hospital readmissions as well. Not everything has been a home run. There have been lots of singles. Birth control is now covered, and teen pregnancy is down. Medicare now pays for outpatient care in some locations (to be expanded), the results are better health care out comes at lower cost. A pilot project in Maine saved $25 million the first year, and $3,000 per patient. That's not huge by itself, but lots of little savings add up. And again, it must be emphasized health care outcomes are improved. Not just lowered costs, better care. The idea is that as service providers learn how to provide better care for their Medicare patients those same policies and procedures will trickle down to the rest of the population. There is good evidence that is already happening.
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-18.htmlAlso worth mentioning...in the 2012 campaign Paul Ryan and Mitt Romney made a big deal about a planned $716 billion cut to Medicare, which would then be spent in other areas. A big portion of those cuts were to the Medicare Advantage program, and were pretty much just pure waste. Romney/ Ryan and others claimed this would result in worse health care for our seniors and maybe an end to the Medicare Advantage program, as insurers ran screaming from the marketplace. But that's not what happened. When the waste was cut out of the program, it became more efficient. As as it became more efficient it became more popular. Enrollment exploded.
http://www.nytimes.com/2016/02/13/us/politics/surge-in-medicare-advantage-sign-ups-confounds-expectations.html?_r=0More people have better insurance at lower cost. That's a solid triple at least. Isn't that exactly how health care reform is supposed to work? I've gone into more detail than I meant to, but as you drill down you find more and more things that have worked really well, both in reducing costs and improving health care outcomes. True enough, the exchanges are not working as well as they should. Congress easily could fix that tomorrow if they wanted, and at very low cost. Certainly at much lower cost than we are saving each year in other areas. In this regard, the Congressional Republicans remind me of a kid who would rather kick over another kid's sand castle than join in building one. Very petty, small individuals, especially given the seriousness of the issue.