To the Editor:
The Nov. 29 edition of the Daily Chronicle brought us a rather jaundiced view of the Affordable Care Act (Margaret Carlson, “Is ‘Obamacare’ challenging enough . . . ?”).
As one of the millions of voters who during the last presidential election preferred Obamacare over Mr. Romney’s no-care plan, I’d like to recommend a more even-tempered view of the Affordable Care Act, this one from Friday’s New York Times (Paul Krugman, “Obamacare’s Secret Success”).
Krugman concentrates on the “affordable” part of the Act, which in 2011 was praised by many health and labor economists as involving “every cost-containment provision policy considered effective in reducing the rate of medical spending.” He points out that in fact real health spending per capita – that is, total spending adjusted for inflation and population growth – has risen since 2010 “less than a third as rapidly as its long-term average”; and “real spending per Medicaid beneficiary has actually fallen.”
These benefits he attributes in part to the Act’s reduction in Medicare subsidies to private insurance, and in part to its encouraging a shift from fee-for-service to “accountable care,” in which “health organizations get rewarded for overall success in improving care while controlling costs.” In addition, when Medicare manages to slow cost growth, “private insurance gets cheaper too.”
Krugman also points out that the biggest savings may be still to come, when the Independent Payment Advisory Board, a panel with power to impose cost-saving measures if Medicare spending grows above target, is established. Now that the congressional filibuster has been reformed, the panel’s appointments can be made without being regularly blocked.
“The news on health care costs is, in short, remarkably good,” Krugman said, adding, however, that we won’t hear much about this good news “until and unless the Obamacare website gets fixed.” But, “under the surface,” he adds, “health reform is starting to look like a bigger success than even its most ardent advocates expected.”