Map of life expectancy at birth from Global Education Project.

Tuesday, July 19, 2016

An informed perspective on the ACA

Former law professor and current federal employee Barack H. Obama offers an assessment of the Affordable Care Act in last week's JAMA. While I don't know if we can count on him to be an entirely disinterested observer, this does have some fair and balanced elements.

He rightly notes that the law has resulted in a huge decline in the proportion of people who lack health insurance, and is plausibly linked to observable improvements in beneficiaries' health status and financial security. He also gives credit to the ACA for slowing the growth of spending on health care, which is a big more speculative at this point.

But he also observes that affordability is a problem for some people. Fixing this would require increasing the funding for subsidies and changing the structure of subsidies to fix some quirks.

The big news, however, is that he notes that the ACA has not succeeded in creating competitive insurance markets in all parts of the country. Therefore, he embraces a publicly sponsored insurance option, a Medicare for all style program, where competition is lacking. This goes part of the way toward Bernie Sanders, who of course wants that everywhere. It's a pretty kludgy fix -- it would need an on/off switch depending on the current competitiveness of the market in a given region, which doesn't seem very workable.

Biggest problem, of course, is that there is no way in the Delta quadrant of the galaxy that a Republican House would ever pass this. But, it does give Hillary something to campaign on.

Side Note: That the major scandal to come out of last night's hate fest on the lake is that Melania Trumps speech contained some purloined words tells us everything we need to know about the corporate media. Blatant ugly lies; bigotry; depraved fear mongering: all okay worthy only of stenography. Non-politician given ghost written speech that contains a bit of borrowing -- that's your screaming headline. Bring on the giant meteorite.

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