Wednesday, December 31, 2014
Actually not a bad year on the health care front
Yes, the habit of looking back on this date is arbitrary but I suppose I should do it.
The Affordable Care Act is working, better than just about anybody expected. The number of uninsured adults in the U.S. fell by about 9.5 million. According to a poll, most of the people who gained coverage said they had seen a doctor or filled a prescription, which they could not have afforded previously.
And the relentless, unsustainable growth in spending on health care has stopped. In fact Medicare spending per beneficiary actually declined. It's too soon to say for sure why this has happened, but it's consistent with the ACA working the way it is supposed to, reinforcing an ongoing cultural shift in health care that I've talked about a lot here. Doctors are much more conscious now of the harm done by overdiagnosis and overtreatment. We are far from realigning the financial incentives throughout the health care system to reward quality rather than volume, but the ACA starts the process and private insurers as well as Medicare are trying out new models of payment.
For all of the decades I've been in this field, we've heard the same message over and over. Health care spending is growing unsustainably and fewer and fewer people have access to the care they need. Disaster was looming and nothing was happening to prevent it. Well, all of a sudden, that stopped. The situation actually started to improve. The threat of Medicare driving the federal government to insolvency receded, more people got coverage, and quality actually appears to be improving.
And yet pollsters tell us the ACA is unpopular and one of our two major parties is committed to repealing it above all other causes. It's just crazy. They won't be able to do it as long as Barack Obama holds the veto pen, but the Supreme Court could do it for them by ignoring 125 years of jurisprudence and common sense. They just might.