Category Archives: Health Care

“Handing out health insurance cards is a less challenging task than bringing down the price of health-care services.”

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I’ve read a number of Sarah Kliff’s pieces on health care economics and legislation over at Wonkblog in recent weeks.  Good columns.  (The title of this post is taken from one of them.)  She recognizes that it’s not sufficient to pass legislation and hope for the best.  If health care costs need to be brought down then you need to have a plan for reducing them.  For example, several weeks ago she wrote about Oregon’s plan to reduce health care cost growth.  It sounds like Oregon has a plausible plan.  If it succeeds – great.  If not, then there will be lessons learned moving forward.  Whether or not it succeeds, it’s a serious effort to achieve necessary ends.  There needs to more of that the federal, state, and local levels.  With that in mind, here’s Ms. Kliff on health care spending MA:

Danger ahead? Massachusetts health costs are rising – fast.  by Sarah Kliff (emphasis mine):

Massachusetts has been at the forefront of experimenting with new ways to keep health-care spending down after decades of sharp increases. Last year, it passed a law that put health costs under a global budget: They cannot grow faster than the rest of the Bay State economy.

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John McDonough, Holes in the ACA: A Damage Assessment

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From John McDonough, Holes in the ACA:  A Damage Assessment, an evaluation of the modifications to the Affordable Care Act (Obamacare) since it was enacted:

By my count … there have been eight consequential, substantive changes to the ACA since its signing in March 2010.  Seven were done by Congress and one by the U.S. Supreme Court (SCOTUS). I list them in order of consequence, recognizing that many will disagree with my rankings:

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ACA Implementation Issues

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UC-Berkeley economist Brad DeLong asks the a tough question re ACA implementation:

I understand that [Centers for Medicare & Medicaid Services] has absolutely no desire to encourage more cream-skimming, and every desire and internal incentive to make sure that those who treat more difficult patient populations are not financially penalized by doing so.

I understand that as a country we are spending twice as much as western European countries while lagging 2 years behind them in life expectancy and 20% behind them in treatment coverage. I understand that the hope is that it will be cheaper and quicker to treat your 32 million new Medicaid and exchange-based insured now that they are showing up regularly with insurance rather than showing up in severe crisis only.

But Massachusetts has been walking down this exchange-and-public-program-expansion road for six years now, since Mitt Romney signed RomneyCare. Massachusetts has been vacuuming up doctors and nurses from Costa Rica and elsewhere and still has been finding that the cost of treating your state population is higher when 97% are insured than it was when 88% were insured. And there aren’t enough loose doctors and nurses in the rest of the world for the ACA to vacuum up enough of them to meet the needs of not 1 state but 50 states.

The investments in medical infrastructure and workforce–less than $30 billion for 32 million newly insured, less than $1000 for newly insured–seem an order of magnitude low.

What is your guess as to what will happen if the ACA works for access, works for quality, works for coverage–but the extra health-care workforce needed isn’t there, and the lines start to get longer?

A few thoughts related to Brad’s question:
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