Monday, January 05, 2015
More you didn't know about the ACA
Yes, it's Socialism-Fascism-Muslimism-Freedom Destroying-Anti-American-Communist-Atheism, but it also, in addition to getting millions of people health insurance, makes health care better. And a lot of the ways it does that are apparently a secret, at least if you rely on the corporate media for your information.
Did you know that the ACA requires private health plans to cover all the services that have received an A or a B rating from the U.S. Preventive Services Task Force? An A rating means "The USPSTF recommends the service. There is high certainty that the net benefit is substantial," and a B rating means "The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial." In other words, they've studied the issue deeply and concluded that the thing is worth doing. Oh yeah, these services have to offered without patient cost-sharing.
Now, in many cases, these services would actually reduce health care spending in the long run. (Not necessarily -- something can be worth doing even if it actually costs money, but we'll deal with that another time.) An example is smoking cessation interventions -- counseling, nicotine replacement, and other pharmaceutical treatments. These aren't magic bullets, but they do raise quit rates.
Via Tim McAfee et al in the new JAMA (subscription only, alas), when Massachusetts added smoking cessation services to its Medicaid program in 2006, the smoking rate among beneficiaries fell from 38% to 28%, hospitalizations for myocardial infarction fell by nearly half, and there were $3.12 in savings for every dollar spent. (Land, et al, here )
So okay, you may ask, this being so, why don't all insurers already do this? Why do we need a law? Don't they want to save money? Well, here's the problem . . .
The savings will only be realized over a considerable period of time, but the money is spent now. By the time you don't have that heart attack or lung cancer, you won't be in that insurer's plan any more. In fact you'll probably be on Medicare, but even if not, there's a lot of turnover among enrollees. In a single payer system, you don't have this problem, but we do here in the U.S. of A. Only by passing a law requiring that insurers offer these services can the social benefit be realized. (And all insurers will actually benefit in the end -- what we have here is a version of the "free rider" problem.)
There are other goodies in the ACA. We'll get to them.