Thursday, November 3, 2011
I've been reading three recent independent pieces that when looked at together cast renewed doubt on the "affordable" part of the reform act's title.
First, Gail Wilensky, writing in the New England Journal, here, about PGPs, the ACO beta test, while noting some good news on quality measures, paints a gloomier picture on the cost front, "The savings are another matter. Even with all their experience, only two of the PGP participants were able to exceed a 2% savings threshold the first year of the demo, and only half managed to surpass that threshold after 3 years. Even within this group, the shared savings varied widely among the PGPs."
Over at the Incidental Economist Aaron Carroll, here, takes issue with the political/pseudo-populist argument that ACA shorn of the individual mandate will find more acceptance. His comment, "I have yet to see any convincing data that show there’s a significant portion of America that loves the ACA, but hates the mandate…. If the individual mandate goes, more healthy people will opt out of buying insurance in the exchanges. The likely result will be an increase in premiums, and a subsequent increase in subsidies required to make them “affordable”, which will drive up the long term projections of the price of the law. If the premiums go up too fast, the market could fail."
Finally, where are all the lobbying dollars? Dan Diamond, writing at California Healthline, here, suggests "Industry stakeholders largely are sitting on the sideline this time. Moreover, many are wishing away the GOP's repeal because it wouldn't benefit the health care sector."
Overall, the detachment of the political discourse from policy, or economics, or even reality continues to be striking. [NPT]