Job creation isn't the only accomplishment of President Obama's that Republicans are refusing to acknowledge. That's particularly true when it comes to Obamacare—to hear them on the issue, you'd think it's impoverishing and killing everyone who comes near it. That's because, when they're busy repealing it, they are also voting to repeal some amazing thing. Like 87,000 saved lives, just in hospital care alone.
Some of the see-what-sticks cost experiments also seem to be improving care. One recent report found that infections and other "hospital-acquired conditions" have declined 17 percent since 2010, when Obamacare created financial incentives for hospitals to avoid them. That reduction saved an estimated 87,000 lives and $20 billion. A similar effort to incentivize better management of discharged patients has coincided with a decline in hospital readmission rates that's keeping 150,000 more Medicare patients at home every day, according to Meena Seshamani, director of the administration's Office of Health Reform.
Under Obamacare, about one-fifth of Medicare patients have already shifted into alternatives to fee-for-service, and the goal is to get half the system paying for value rather than volume by 2018. Maryland’s hospitals are now paid through "global budgets" that include outpatient care, so they no longer have incentives to admit patients just to keep their beds full. A recent New England Journal of Medicine article found the state's hospital costs increased at less than half the expected rate in the program’s first year, saving Medicare $116 million. There are signs that Obama's convoluted jumble of changes may be starting to rationalize an irrational system. Patrick Conway, the director of the new innovation center, told me about a new Independence at Home experiment that coordinates nurse and doctor visits for frail and disabled patients—and saved Medicare $3,000 per beneficiary in its first year. One elderly diabetic who had 19 hospitalizations the previous year had only one after enrolling in the program.
This is what Republicans intend to repeal. The whole point of the vote they had last week, doomed as it was to presidential veto, was to set the stage for a Republican president who would sign their repeal. That repeal would sentence who knows how many people to premature deaths and back to the uncertainty that Republicans have forced on all the people living in the Medicaid gap now. Just to be clear, that's what they are planning on.
What they're not planning, five years into this, is replacing it.