“Obamacare’s Secret Success”: Health Reform Is Starting To Look Like A Bigger Success Than Even Its Most Ardent Advocates Expected
The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act. And the “affordable” bit wasn’t just about subsidizing premiums. It was also supposed to be about “bending the curve” — slowing the seemingly inexorable rise in health costs.
Much of the Beltway establishment scoffed at the promise of cost savings. The prevalent attitude in Washington is that reform isn’t real unless the little people suffer; serious savings are supposed to come from things like raising the Medicare age (which the Congressional Budget Office recently concluded would, in fact, hardly save any money) and throwing millions of Americans off Medicaid. True, a 2011 letter signed by hundreds of health and labor economists pointed out that “the Affordable Care Act contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending.” But such expert views were largely ignored.
So, how’s it going? The health exchanges are off to a famously rocky start, but many, though by no means all, of the cost-control measures have already kicked in. Has the curve been bent?
The answer, amazingly, is yes. In fact, the slowdown in health costs has been dramatic.
O.K., the obligatory caveats. First of all, we don’t know how long the good news will last. Health costs in the United States slowed dramatically in the 1990s (although not this dramatically), probably thanks to the rise of health maintenance organizations, but cost growth picked up again after 2000. Second, we don’t know for sure how much of the good news is because of the Affordable Care Act.
Still, the facts are striking. Since 2010, when the act was passed, real health spending per capita — that is, total spending adjusted for overall inflation and population growth — has risen less than a third as rapidly as its long-term average. Real spending per Medicare recipient hasn’t risen at all; real spending per Medicaid beneficiary has actually fallen slightly.
What could account for this good news? One obvious answer is the still-depressed economy, which might be causing people to forgo expensive medical care. But this explanation turns out to be problematic in multiple ways. For one thing, the economy had stabilized by 2010, even if the recovery was fairly weak, yet health costs continued to slow. For another, it’s hard to see why a weak economy would have more effect in reducing the prices of health services than it has on overall inflation. Finally, Medicare spending shouldn’t be affected by the weak economy, yet it has slowed even more dramatically than private spending.
A better story focuses on what appears to be a decline in some kinds of medical innovation — in particular, an absence of expensive new blockbuster drugs, even as existing drugs go off-patent and can be replaced with cheaper generic brands. This is a real phenomenon; it is, in fact, the main reason the Medicare drug program has ended up costing less than originally projected. But since drugs are only about 10 percent of health spending, it can only explain so much.
So what aspects of Obamacare might be causing health costs to slow? One clear answer is the act’s reduction in Medicare “overpayments” — mainly a reduction in the subsidies to private insurers offering Medicare Advantage Plans, but also cuts in some provider payments. A less certain but likely source of savings involves changes in the way Medicare pays for services. The program now penalizes hospitals if many of their patients end up being readmitted soon after being released — an indicator of poor care — and readmission rates have, in fact, fallen substantially. Medicare is also encouraging a shift from fee-for-service, in which doctors and hospitals get paid by the procedure, to “accountable care,” in which health organizations get rewarded for overall success in improving care while controlling costs.
Furthermore, there’s evidence that Medicare savings “spill over” to the rest of the health care system — that when Medicare manages to slow cost growth, private insurance gets cheaper, too.
And the biggest savings may be yet to come. The Independent Payment Advisory Board, a panel with the power to impose cost-saving measures (subject to Congressional overrides) if Medicare spending grows above target, hasn’t yet been established, in part because of the near-certainty that any appointments to the board would be filibustered by Republicans yelling about “death panels.” Now that the filibuster has been reformed, the board can come into being.
The news on health costs is, in short, remarkably good. You won’t hear much about this good news until and unless the Obamacare website gets fixed. But under the surface, health reform is starting to look like a bigger success than even its most ardent advocates expected.
By: Paul Krugman, Op-Ed Columnist, The New York Times, November 28, 2013
“Rooting For Failure”: Hard To Remember A Time When A Major Political Party And Its Media Arm Rooted For Fellow Americans To Lose
I just spent 15 minutes on my local health care exchange and realized that I could save a couple hundred dollars a month on my family’s insurance. Of course, I live in Washington State, which has a very competitive market, a superbly functioning website and no Koch-brothers-sponsored saboteurs trying to discourage people from getting health care.
California is just as good. It’s enrolling more than 2,000 people a day. New York is humming as well. And Kentucky, it’s the gold standard now: More than 56,000 people have signed up for new health care coverage — enough to fill a stadium in Louisville.
This is terrible news, and cannot be allowed to continue. If there’s even a small chance that, say, half of the 50 million or so Americans currently without heath care might get the same thing that every other advanced country offers its citizens, that would be a disaster.
But not to worry. The failure movement is active and very well funded. You probably know about the creepy Uncle Sam character in ads financed by the Koch brothers. Sicko Sam is seen leering over a woman on her back in a hospital exam room, her legs in stirrups. This same guy is now showing up on college campuses, trying to get young people to opt out of health care. On some campuses, he plies students with free booze and pizza — swee-eeet!
The Republican Party started a failure campaign earlier this year, but then the strategy got sidetracked in a coercive government shutdown that cost us all $24 billion or so. With the disastrous rollout of the federal exchange, Republicans now smell blood. A recent memo outlined a far-reaching, multilevel assault on the Affordable Care Act. Horror stories — people losing their lousy health insurance — will be highlighted, and computer snafus celebrated.
Ron Paul, the nuttier of the two political Pauls, recently suggested to a crowd in Virginia that “nullification” of the health care law might be the best way to kill it. I’m not sure what he meant by that, but it sounds illegal.
It’s hard to remember a time when a major political party and its media arm were so actively rooting for fellow Americans to lose. When the first attempt by the United States to launch a satellite into orbit, in 1957, ended in disaster, did Democrats start to cheer, and unify to stop a space program in its infancy? Or, when Medicare got off to a confusing start, did Republicans of the mid-1960s wrap their entire political future around a campaign to deny government-run health care to the elderly?
Of course not. But for the entity of the Obama era, Republicans have consistently been cheerleaders for failure. They rooted for the economic recovery to sputter, for gas prices to spike, the job market to crater, the rescue of the American automobile industry to fall apart.
I get it. This organized schadenfreude goes back to the dawn of Obama’s presidency, when Rush Limbaugh, later joined by Senator Mitch McConnell, said their No. 1 goal was for the president to fail. A CNN poll in 2010 found 61 percent of Republicans hoping Obama would fail (versus only 27 percent among all Americans).
Wish granted, mission accomplished. Obama has failed — that is, if you judge by his tanking poll numbers. But does this collapse in approval have to mean that the last best chance for expanding health care for millions of Americans must fail as well?
Does this mean we throw in the towel, and return to a status quo in which insurance companies routinely cancel policies, deny health care to people with pre-existing conditions and have their own death panel treatment for patients who reach a cap in medical benefits?
The Republican plan would do just that, because they have no plan but to crush the nation’s fledgling experiment. Sometimes they bring up vouchers, or tort reform, or some combination of catchphrases. Here was Sarah Palin, who is to articulate reason what Mr. Magoo is to vision, on the Republican alternative, as she told Matt Lauer:
“The plan is to allow those things that have been proposed over many years to reform a health care system in America that certainly does need more help so that there’s more competition, there’s less tort-reform threat, there’s less trajectory of the cost increases. And those plans have been proposed over and over. And what thwarts those plans? It’s the far left.”
Yes, it is a big and legitimate news story, for a presidency built on technical expertise, that the federal exchange is not working as promised. Ditto Obama’s vow that people could keep their bottom-feeder health care policies.
But where were the news conferences, the Fox News alerts, the parading of people who couldn’t get their lifesaving cancer treatments under the old system? Where was the media attention when thousands of people were routinely dumped once they got sick? When did Republicans in Congress hold an oversight hearing on the leading cause of personal bankruptcy — medical debt?
All of that is what we had before. And all of that is what we will return to if some version of the Affordable Care Act is not made workable. Republicans have a decent chance, in next year’s elections, of killing the dream of progressive presidents going back to Teddy Roosevelt. But they shouldn’t count on it. What’s going against them, or any party invested in failure, is that Americans are inherently optimistic. That alone may be enough to save Obamacare.
By: Timothy Egan, Contributing Op-Ed Writer, The New York Times, November 28, 2013
“News People Can Actually Use”: The Media Needs To Do More To Help People Navigate Obamacare
Yesterday, Tim Noah made a point in an MSNBC appearance that I think deserves a lot more attention. Media outlets have been doing lots of reporting on the problems of the Affordable Care Act rollout. What they haven’t done is provided their audiences with practical information that could help them navigate the new system. Of course, most Americans don’t have to do anything, since they have employer-provided insurance. But for all the attention we’ve been paying to the individual market, media outlets haven’t done much to be of service. “The New York Times has published the URL for the New York exchange exactly twice,” Noah said, “both before October first.”
My experience in talking to journalists about the publication of this kind of thing—unsexy yet useful information, whether it’s how to navigate a new health law or understanding where candidates stand on issues—is that they often think that addressing it once is enough. When you ask them about it, they’ll say, “We did a piece on that three months ago.” The problem is that for it to be effective, they have to do it repeatedly or people won’t get it. What we have seen is that this information can be found somewhere on news outlets’ websites (here’s an example), but it isn’t on the evening-news broadcast or in the print edition of the paper.
Of course, conservatives would allege that if a newspaper writes a guide to getting insurance through the new exchange, it has demonstrated its liberal bias and become an arm of the Obama administration. But it’s the law. As of next year, if you don’t get insurance through your employer, you need to go to an exchange. Media outlets would just be helping people do what they have to do. I suppose conservatives could also argue that if the local paper puts up a tool on its website that helps people find their polling places and tells them what the voting hours are, it’s just trying to boost turnout, and everybody knows that helps Democrats. Or that if it reminds you to file your tax returns on April 15th, then it’s just helping fund big government. Or that if it tells you to set your clocks back for daylight savings, it’s just feeding the Illuminati/Bilderberg time-theft conspiracy.
People sometimes mock “news you can use” because it’s often delivered in forms that aren’t particularly useful (“There’s a silent killer in your refrigerator right now!”). But helping citizens understand and respond to changes in the law is part of any major media outlet’s mission. The fact that a law is controversial doesn’t absolve them of the responsibility.
By: Paul Waldman, Contributing Editor, The American Prospect, November 27, 2013
“Corporations Aren’t People”: If Given The Freedoms Of “People”, Corporations Should Be Subjected To Obligations And Restrictions Too
If you thought this “corporations are people” business was getting out of hand, brace yourself. On Tuesday, the Supreme Court accepted two cases that will determine whether a corporation can deny contraceptive coverage to its female employees because of its religious beliefs.
The cases concern two of the most politically charged issues of recent years: who is exempted from the requirements of the Affordable Care Act, and whether application of the First Amendment’s free speech protections to corporations, established by the court’s 2010 decision in Citizens United, means that the First Amendment’s protections of religious beliefs must also be extended to corporations.
The Affordable Care Act requires employers to offer health insurance that covers contraception for their female employees. Churches and religious institutions are exempt from that mandate. But Hobby Lobby, a privately owned corporation that employs 13,000 people of all faiths — and, presumably, some of no faith — in its 500 craft stores says that requiring it to pay for contraception violates its religious beliefs — that is, the beliefs of its owners, the Green family.
In a brief submitted to a federal court, the Greens said that some forms of contraception — diaphragms, sponges, some versions of the pill — were fine by them, but others that prevented embryos from implanting in the womb were not. The U.S. Court of Appeals for the 10th Circuit upheld the Greens’ position in June in a decision explicitly based on “the First Amendment logic of Citizens United.” Judge Timothy Tymkovich wrote: “We see no reason the Supreme Court would recognize constitutional protection for a corporation’s political expression but not its religious expression.”
Tymkovich’s assessment of how the five right-wing justices on the Supreme Court may rule could prove correct — but what a mess such a ruling would create! For one thing, the Green family’s acceptance of some forms of contraception and rejection of others, while no doubt sincere, suggests that they, like many people of faith, adhere to a somewhat personalized religion. The line they draw is not, for instance, the same line that the Catholic Church draws.
Individual believers and non-believers draw their own lines on all kinds of moral issues every day. That’s human nature. They are free to say that their lines adhere to or are close to specific religious doctrines. But to extend the exemptions that churches receive to secular, for-profit corporations that claim to be following religious doctrine, but may in fact be nipping it here and tucking it there, would open the door to a range of idiosyncratic management practices inflicted on employees. For that matter, some religions have doctrines that, followed faithfully, could result in bizarre and discriminatory management practices.
The Supreme Court has not frequently ruled that religious belief creates an exemption from following the law. On the contrary, in a 1990 majority opinion, Justice Antonin Scalia wrote that Native Americans fired for smoking peyote as part of a religious ceremony had no right to reinstatement. It “would be courting anarchy,” Scalia wrote in Employment Division v. Smith, to allow them to violate the law just because they were “religious objectors” to it. “An individual’s religious beliefs,” he continued, cannot “excuse him from compliance with an otherwise valid law.”
It will be interesting to see whether Scalia still believes that now that he’s being confronted with a case where the religious beliefs in question may be closer to his own.
The other issue all this raises: Where does this corporations-are-people business start and stop? Under the law, corporations and humans have long had different standards of responsibility. If corporations are treated as people, so that they are free to spend money in election campaigns and to invoke their religious beliefs to deny a kind of health coverage to their workers, are they to be treated as people in other regards? Corporations are legal entities whose owners are not personally liable for the company’s debts, whereas actual people are liable for their own. Both people and corporations can discharge their debts through bankruptcy, but there are several kinds of bankruptcy, and the conditions placed on people are generally far more onerous than those placed on corporations. If corporations are people, why aren’t they subject to the same bankruptcy laws that people are? Why aren’t the owners liable for corporate debts as people are for their own?
If corporations are going to be given the freedoms that people enjoy, they should be subjected to people’s obligations and restrictions too. I’m not sure how many corporations would think that’s such a good deal.
By: Harol Meyerson, Opinion Writer, The Washington Post, November 26, 2013
“The Rise Of Obamacare McCarthyism”: Anti-Obamacare Republicans Attack Each Other For Being “Crypto-Supporters” Of Obamacare
We talked yesterday about Rep. Jack Kingston, one of several House Republicans running for the U.S. Senate in Georgia, who infuriated the right. His transgression? The congressman pushed a bill to add a conservative provision to the Affordable Care Act.
Conservatives were livid, not because of the idea itself, but because House Republicans aren’t supposed to try to “fix” the health care law. To take even a modest step towards moving the law to the right, some conservatives said, is to “surrender on Obamacare.”
We’re seeing a similar situation play out in Wyoming.
A conservative nonprofit group is set to launch a TV attack ad Monday intimating that Republican Sen. Mike Enzi is less than pure in his opposition to Obamacare.
Americans for Job Security highlights the incumbent’s support for exchanges during the 2010 debate over Obamacare…. “I like the exchanges,” Enzi says in a brief clip. “These exchanges can be good.”
The ad is incredulous, as if the senator’s 2010 comments are ridiculous are on their face. It doesn’t matter if Enzi has repeatedly fought to destroy the Affordable Care Act and voted to repeal it; what matters now is that he once said it’s possible that marketplaces with competing private insurance plans are “good.”
And in 2013, that’s apparently a bridge too far.
What’s emerging is an expansive list of litmus tests – it’s not enough to hate “Obamacare,” Republicans must also hate everything within the law, including the Republican ideas.
In this case, the Wyoming attack ad concludes, “Tell Mike Enzi we don’t like these liberal, Big Government Obamacare exchanges.”
Got that? If private insurers compete for consumers’ business in a marketplace originally touted by the Heritage Foundation, it’s “liberal, big government.”
It’s hard to believe in the most gullible GOP primary voter would find this persuasive, but the takeaway here is the attack itself. We’ve reached the point at which a far-right Republican is being condemned for having described the single most capitalistic, free-market aspect of the health care law as “good.”
Josh Marshall described this as an example of “Obamacare McCarthyism,” in which “different anti-Obamacare Republicans attack each other for either being crypto-supporters of Obamacare, being Obamacare-curious or even just having earlier periods of Obamacare confusion.”
Ed Kilgore added this is “likely to be a continuing weapon against any Republican who doesn’t favor the most radical tactics available at any given moment to bring down the Great White Whale of the Affordable Care Act.”
By: Steve Benen, The Maddow Blog, November 27, 2013
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