Skip to main content

in Obamacare’s Secret Success he tells us that despite the problems and complaints it is working in one key regard, holding down the growth of medical spending, or as it has been described, bending the curve of the expansion of spending.

In one sense this should not have been a surprise, despite the conventional wisdom in Washington, in which the thinking is skewed:  

The prevalent attitude in Washington is that reform isn’t real unless the little people suffer; serious savings are supposed to come from things like raising the Medicare age (which the Congressional Budget Office recently concluded would, in fact, hardly save any money) and throwing millions of Americans off Medicaid. True, a 2011 letter signed by hundreds of health and labor economists pointed out that “the Affordable Care Act contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending.” But such expert views were largely ignored.
 So Krugman asked who was right, has in fact, the curve been bent, and answers
The answer, amazingly, is yes. In fact,the slowdown in health costs has been dramatic.
There is more to the story.

Krugman examines possible reasons for the slowdown, the bending of the curve.

For those who think it might simply be the depressed economy, Krugman points out that the economy had largely recovered by 2010, the period when the slowdown begins, so that cannot be the explanation -  and I am quite sure that he is aware that not everyone felt the recovery, but that does not affect the analysis.  After all, it is hard to explain that as a reason for slower inflation in medical spending than in the rest of the economy, and it offers no explanation for why Medicare had an even more dramatic slowing than the rest of the economy.

Nor does the fact that there has been a slowing of medical innovation account for it - yes, there have been fewer blockbuster drugs, and existing drugs continue to go off-patent and get replaced by cheaper generics, which explains why the Part D programs costs have been less than projected,

But since drugs are only about 10 percent of health spending, it can only explain so much.
The biggest single reason?  
So what aspects of Obamacare might be causing health costs to slow? One clear answer is the act’s reduction in Medicare “overpayments” — mainly a reduction in the subsidies to private insurers offering Medicare Advantage Plans, but also cuts in some provider payments. A less certain but likely source of savings involves changes in the way Medicare pays for services. The program now penalizes hospitals if many of their patients end up being readmitted soon after being released — an indicator of poor care — and readmission rates have, in fact, fallen substantially. Medicare is also encouraging a shift from fee-for-service, in which doctors and hospitals get paid by the procedure, to “accountable care,” in which health organizations get rewarded for overall success in improving care while controlling costs.

Furthermore, there’s evidence that Medicare savings “spill over” to the rest of the health care system — that when Medicare manages to slow cost growth, private insurance gets cheaper, too.

Let's stop on this point for a moment and remind ourselves of a point that Krugman does not mention.  Some Republicans demagogue PPACA claiming that it "stole" hundreds of billions from Medicare to fund Obamacare, a point that when Rep Bachmann made it in a Republican primary debate, Politifact rated it "Mostly False".  Demagoguery can be effective - remember "Death Panels?" - even when patently false.  That is one reason this Krugman column is so important.

But Krugman has MUCH MORE to offer.  Savings will get MUCH BIGGER:  

The Independent Payment Advisory Board, a panel with the power to impose cost-saving measures (subject to Congressional overrides) if Medicare spending grows above target, hasn’t yet been established, in part because of the near-certainty that any appointments to the board would be filibustered by Republicans yelling about “death panels.” Now that the filibuster has been reformed, the board can come into being.
Yet another could reason for Harry Reid and the Senate Democrats to have gone nuclear.

But wait, there is still more, as the pitchman on late-night TV used to say.

Consider Krugman's final paragraph:

The news on health costs is, in short, remarkably good. You won’t hear much about this good news until and unless the Obamacare website gets fixed. But under the surface, health reform is starting to look like a bigger success than even its most ardent advocates expected.
Let's repeat the key words:  health reform is starting to look like a bigger success than even its most ardent advocates expected.

Not only are people who could not afford it now getting good coverage, but the plan is lowering costs as the experts predicted, and when fully implemented will save even more.

Which, by the way, nicely undercuts the rhetoric of those who continue to insist upon the necessity of cutting the social safety net as part of some kind of "grand bargain" to "save" the economy from the exploding costs that are supposed to crush us.

This is a very good, and detailed Krugman column.

Read it.

Pass it on.

Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags


More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  From the perspective of the money bags, (17+ / 0-)

    the "safety net" is designed to protect them from the pitchforks and torches. By giving a little, they hope to stave off the hordes.
    It seems that people fixated on accumulating money are very much like squirrels -- instinct-driven. It may even be that they accumulate obsessively because they don't know what to do with what they've got. If so, then society rewarding their hoarding with accolades is doubly counter-productive.
    To our Christian friends committed to salvation, we should make the point that money is for spending; souls are for saving.
    If they've got it backwards, they may not understand, but it should be pointed out.

    Probably the primary reason why federal spending on medical services is so effective is because the relationship between payer and provider is about as direct as it can get. The claim about government getting in between patients and their doctors was patently false. If there was/is an unnecessary middleman in medical/health care, insurance companies are the culprits. Transforming them into delegates of HHS by capping their profit margins is an improvement and, given the size of the population to be served, perhaps even justified. After all HHS could not transition 200 million into its files in a reasonable amount of time. Never mind that the several states were reluctant to cede jurisdiction over the insurers to the feds.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Fri Nov 29, 2013 at 04:23:52 AM PST

    •  I am curious about something (9+ / 0-)

      you regularly decide to offer extensive, sometimes very thoughtful, comments, in many of my diaries, which somehow you do not deem worthy of tipping or recommending.  Is there a reason for that?  I am not complaining, merely trying to understand your thinking.

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Fri Nov 29, 2013 at 04:32:09 AM PST

      [ Parent ]

      •  well, i can't speak for hannah, but i rarely (3+ / 0-)
        Recommended by:
        Cedwyn, hannah, DBoon

        tip or rec any diary. for that matter, i rarely rec comments, because there doesn't seem to be any real value associated with recs. they cost the giver nothing, and grant the recipient little if anything. i've always been a bit mystified why dKos doesn't have a more complex and meaningful rating/policing system -- slashdot had this stuff all worked out before kos posted his first diary.

        To put the torture behind us is, inevitably, to put it in front of us.

        by UntimelyRippd on Fri Nov 29, 2013 at 06:26:28 AM PST

        [ Parent ]

        •  If I think a diary gives good information (5+ / 0-)

          I always rec and tip. Informative comments get a rec from me too, along with ones that I think add to the discussion.

          Why not do that? It helps others to see what everyone thinks, and perhaps points out the best diaries and comments. It takes nothing away from you, as far as I can tell, unless you rec and tip things that are really awful.

          Women create the entire labor force.
          Sympathy is the strongest instinct in human nature. - Charles Darwin

          by splashy on Fri Nov 29, 2013 at 09:54:19 AM PST

          [ Parent ]

        •  UR - RECs are a significant mojo driver (0+ / 0-)

          for both sender and receiver.

          "let's talk about that"

          by VClib on Fri Nov 29, 2013 at 07:52:25 PM PST

          [ Parent ]

          •  And … who the hell needs mojo? (0+ / 0-)

            What use is it to anyone? I mean … I'm sorry, but is there someplace I don't know of where mojo standings are kept, and mojo can be exchanged for something cool, like, say, a front-paged diary or a seat on a panel at Netroots? I know nothing -- absolutely nothing -- about the amount of mojo held by anybody else on this site, nor about the shape of the mojo distribution curve, and I can't think of any reason why I should know or care about it. I don't even know what my own current mojo is -- it has never occurred to me to go to my home page and check.

            Anybody who contributes with any significant frequency rapidly acquires far more mojo than is necessary for … for what exactly? Oh, right -- for handing out more mojo!

            To me, the whole thing is circular and pointless. Both mojo and recs (the larval stage of mojo) are so easy to come by that they don't have any value at all, as far as I can tell. Moreover, I don't generally observe that well-recced comments are especially profound or enlightening or unique. More often, they're just comments that echo a widely-held sentiment, and happen to appear in the right place at the right time.

            If mojo held real value, if it were inherently scarce rather than freely abundant, and if it were based, not only on the sheer quantity of recs, but on some more sophisticated higher-dimensional metric (even the mean or median, for example), things might get interesting around here. If making a comment that was unlikely to attract positive mojo would drag down your mojo level, it might have a pretty striking effect on the overall quality of the conversation.

            Personally, I'm more than a little bemused that teacherken, who enjoys a very high status here, and whose diaries are highly-regarded and typically generate very high recommendation counts, feels any desire to sift through the list of recommenders and wonder about the people whose names are absent.

            To put the torture behind us is, inevitably, to put it in front of us.

            by UntimelyRippd on Sat Nov 30, 2013 at 07:09:56 AM PST

            [ Parent ]

            •  I try to understand how others think (0+ / 0-)

              so when I see something unusual, I inquire

              I don't worry about how many recs I get.

              Meteor Blades has now rightly passed me as the most recommended author in the history of the site.

              Keith Olbermann still has more followers than either of us

              when someone regularly takes the time to read carefully and comment cogently but does not recommend or tip, I want to understand why.  That is not a complaint.

              I am curious.

              I always like to learn new things.

              Sorry if that bothers you.

              "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

              by teacherken on Sat Nov 30, 2013 at 07:39:32 AM PST

              [ Parent ]

              •  well, you've never asked ME why i don't rec (0+ / 0-)

                your diaries. so neener neener.

                it doesn't bother me at all -- it just seemed an unlikely sort of thing for you, of all people, to spend your valuable time doing. if i wrote as many diaries as you do, and they generated reccer lists of comparable length, it wouldn't occur to me to inquire into such questions -- at least, not without a cool stats app that I could point at my diaries and that would dump out a list of, for example, people who wrote highly-recommended comments in my diaries but did not themselves recommend the diary.

                for that matter, had it ever occurred to me that anybody asked such questions, i might have written such an app.

                To put the torture behind us is, inevitably, to put it in front of us.

                by UntimelyRippd on Sat Nov 30, 2013 at 08:13:45 AM PST

                [ Parent ]

                •  you don't write as many long comments (0+ / 0-)

                  on my diaries,  neener neener

                  drop it already

                  "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

                  by teacherken on Sat Nov 30, 2013 at 10:12:28 AM PST

                  [ Parent ]

                  •  "drop it already"? (0+ / 0-)

                    you seem to think that i'm, like, being nasty or even critical or something. i'm really not. you initiated a conversation about something, and i dropped in with a casual observation -- and then with a more extensive comment that was a response to somebody else, regarding the system of recs and mojo.

                    consider it dropped.

                    To put the torture behind us is, inevitably, to put it in front of us.

                    by UntimelyRippd on Sat Nov 30, 2013 at 10:56:31 AM PST

                    [ Parent ]

      •  there's no requirement (1+ / 0-)
        Recommended by:

        that one rec or tip before commenting in a diary.

        Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

        by Cedwyn on Fri Nov 29, 2013 at 06:43:01 AM PST

        [ Parent ]

      •  Really, I'm sorry. I do know it means a (3+ / 0-)
        Recommended by:
        Lujane, divineorder, nio

        lot to you, but sometimes I forget. Also, if the diary is already on the rec list where it will get more eyes, it doesn't seem important to add more.
        After writing a long comment I do try to remember to go back to the head of the diary and recommend, but, as I said, sometimes I forget. :)

        Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

        by hannah on Fri Nov 29, 2013 at 08:53:57 AM PST

        [ Parent ]

        •  no need to apologize (6+ / 0-)

          and frankly, I don't really worry about whether most of my diaries get recommended or not - there are some whose purpose is to make visible the work of others, and those I do care about

          it was more a question of curiosity -  usually, unless I am strongly disagreeing, when I take the time to comment extensively on a diary I tip or recommend or both as a quick acknowledgement of the work of the person I am reading.  That's just my practice.

          "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

          by teacherken on Fri Nov 29, 2013 at 08:58:54 AM PST

          [ Parent ]

          •  You tend not to rec comments? (4+ / 0-)
            Recommended by:
            divineorder, ccyd, teacherken, indres

            I have noticed this, for example you didn't rec hannah's nice apology/explanation above. Or any of the comments I have ever posted in your diaries, LOL. I have always assumed that as a teacher, reader, and frequent diarist you just don't have the time to go fussing at individual comments and have never thought this was an issue. But I have noticed it. Sometimes careful diarists make a point of reccing everyone who takes the trouble to comment--VL Baker as an example--if you speak up, she recs you and this may have the effect of encouraging community at least within the diary.

            I'm not in the least suggesting you might change your style--just keep doing what you're doing. However I think you should recognize that different people spend their time and mental effort differently, and not expect that it means anything if someone doesn't rec you.

            For example, I often don't rec your diaries even if I read and enjoy them, just because I see they are already on the rec list and visible, so I don't take the trouble. If I read a more obscure diary that seems worth reading I am more likely to take the trouble to tip & rec, just to raise the visibility so others can read it.

            Where in the Constitution does it say: "...on behalf of corporate interests" ???

            by sillia on Fri Nov 29, 2013 at 10:22:37 AM PST

            [ Parent ]

            •  Actually I do rec quite a few comments (1+ / 0-)
              Recommended by:

              and my bad because the comment that started this subthread I meant to rec but simply forgot - I have rectified that now

              "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

              by teacherken on Fri Nov 29, 2013 at 11:28:00 AM PST

              [ Parent ]

            •  take a look how many comments on this (0+ / 0-)

              diary I have already recommended

              "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

              by teacherken on Fri Nov 29, 2013 at 11:28:30 AM PST

              [ Parent ]

              •  I didn't mean it as a criticism (0+ / 0-)

                really, I take it back, LOL!!! I was just trying to show that you can't draw meaningful conclusions necessarily from how/whether people use this feature. It just isn't that important to some people. As for reccing diaries, in my case, because of my antiquated computer, scrolling back or up to rec and tip is so cumbersome that I have to remind myself to make that effort, and it's kind of a pain. So I'll do it mostly when a diary "needs" help. But you wouldn't be able to determine disapproval from my lack of reccing, if you see what I mean.

                Where in the Constitution does it say: "...on behalf of corporate interests" ???

                by sillia on Fri Nov 29, 2013 at 11:32:48 AM PST

                [ Parent ]

                •  let me explain again (0+ / 0-)

                  I was not inquiring of hannah because of her failure to recommend this particular diary, but because she is a regular contributor, often very thoughtful, to the threads on my diaries and yet I rarely saw and simply asked why out of curiosity to better understand her thinking

                  "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

                  by teacherken on Fri Nov 29, 2013 at 11:40:02 AM PST

                  [ Parent ]

      •  I'm a Forgetter (0+ / 0-)

        Probably others are too.

        Readers & Book Lovers Pull up a chair! You're never too old to be a Meta Groupie

        by Limelite on Fri Nov 29, 2013 at 01:55:40 PM PST

        [ Parent ]

  •  Dean Baker wrote much the same (3+ / 0-)
    Recommended by:
    Mostel26, jrand, Rogneid

    read it at Huffpo.  Even went so far  computer saying it would be ok giving Obama credit for the drip in costs.   Will look up the link once I get up and on computer.  Thanks
     the post.

    Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

    by divineorder on Fri Nov 29, 2013 at 04:35:59 AM PST

    •  Ack, sorry, commenting by smartphone. Let's (16+ / 0-)

      try this again.

      Thanks for the interesting post.

      Huffpo recently published a post by Dean Baker, who  wrote much the same as PK about costs coming down :

      Dean Baker
      Co-director, CEPR; author, 'The End of Loser Liberalism: Making Markets Progressive'
      More Pain From the ACA: Spending Less on Health Care
      Posted: 11/25/2013 9:27 pm
      It was interesting that Baker, a frequent critic of the Administration, suggested that President Obama could be given credit for this reduction in costs albeit through  somewhat tortured logic at the end of his post.

      Costs coming down are good, but Democrats should still  work for cuts in the obscene   spending on military, NSA privatization, War on Drugs,  etc and use that money to take care of the 20 million plus who still will be left without coverage after full implementation. While celebrating successes of the ACA is important,we also should redouble our efforts and continue reform and transformation for the those millions.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Fri Nov 29, 2013 at 05:45:16 AM PST

      [ Parent ]

      •  The rampant price inflation in health care ... (0+ / 0-)

        ... services has been the problem. That's what drove the slow motion collapse of the system of employer provided health insurance.

        Slowing or halting it temporarily is, of course, not necessarily a permanent fix, because of the standing threat of regulatory capture means that the effectiveness of these controls is likely to erode over time ...

        ... but getting breathing room is still a big win.

        And if the HIX have an opportunity to get entrenched as part of the current system that people want to see protected, that offers a better setting in which to get premium-buy-in Medicare (and Medicaid for people in the subsidy-up-front tier) into the HIX as options, if it comes time that regulatory capture has been able to get the health care service price inflation going again.

        Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

        by BruceMcF on Fri Nov 29, 2013 at 11:38:28 AM PST

        [ Parent ]

        •  See comment below, where PNHP doc (0+ / 0-)

          argues that its the pushing of costs onto consumers and their being unable or unwilling to pay so drop in demand.

          Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

          by divineorder on Fri Nov 29, 2013 at 11:52:52 AM PST

          [ Parent ]

        •  Job based benefits don't make economic sense (0+ / 0-)

          Employer provided health care is an accident of US economic history.  It should have collapsed long ago.  Its collapse is accelerating because employers are being allowed to get rid of all benefits: sick leave, health care, pensions.

          Lets be clear about this.  We should move benefits into the social sphere and tax accordingly.
          -tax carried interest
          -remove the fica cap
          -expand social security to replace private pensions
          -phase out 401k deductability
          -phase out new Roth contributions

          Medicare for All: the cleanest slogan and the best way forward.

          by furiouschads on Fri Nov 29, 2013 at 04:38:53 PM PST

          [ Parent ]

          •  Certainly the system of job-based benefits that .. (0+ / 0-)

            ... we had evolved made little economic sense.

            As far as what "we should do", the shortage is not lists of changes that should be made, but a movement with the political power to put them into place. That will be easier to organize if in two and three years the HIX are seen as something worth saving, so that those with approaches that improve them have a point of leverage against bitter enders still trying to "Repeal Obamacare".

            Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

            by BruceMcF on Fri Nov 29, 2013 at 05:34:11 PM PST

            [ Parent ]

  •  I love me some Krugmann eom (6+ / 0-)
  •  The Royals of Washington will be who they are and (9+ / 0-)

    it is up to us to vote and use our other time wisely to effect change so people reach out to each other again.  The ACA does this and it slows medical care cost growth.  Great.

  •  this aspect needs much more trumpeting. (13+ / 0-)

    the cost curve is probably the most important part of the ACA, but its decidedly unsexy.  the media would much rather focus on drama (viz, the federal exchange website) and will always miss the stuff that's more important but also more complicated and less big and shiny.

    so thx to Krugs for championing it and you for bringing it to our attention.

  •  Krugman's approach is wrong (6+ / 0-)
    Recommended by:
    LI Mike, Gooserock, Chi, Rogneid, DRo, ichibon

    He offers caveats. Republicans never offer caveats. They just make blanket statements. So a good Republican writing this article would have said simply ACA is DRIVING down costs. No caveats, just simple fact. Trying to compete intellectually with a big lying machine is so damn hard

    •  But Krugman is Writing in NYT Not USA Today (8+ / 0-)

      and he is a scholar not a movement leader or politician.

      You're right about politically motivating messaging. Krugman shares the illusions of the left that there is still leadership willing to listen to facts when the reality is that, like climate scientists, his intended audience is no longer at the helm.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Fri Nov 29, 2013 at 05:30:45 AM PST

      [ Parent ]

    •  chuck - Krugman knows that in something as (0+ / 0-)

      dynamic as healthcare costs, it is impossible to isolate one variable. As a serious academician he isn't going to make unsupported claims for political reasons.

      "let's talk about that"

      by VClib on Fri Nov 29, 2013 at 07:57:33 PM PST

      [ Parent ]

  •  This doc notes a darker reason for falling costs; (19+ / 0-)

    all of us in primary care have seen a dramatic rise in rates of 'no-shows', in patients who call begging to be treated over the phone, in patients who are taking their cholesterol and blood pressure meds every other day, patients asking for samples...

    Millions of patients have been herded into brutal high-deductible 'insurance' where the first $2,000, or $4,000, or even $8,000 in medical costs comes right out of pocket. Together with flat or declining wages, high enegy costs and rising food prices, many of my middle class patients are so hard-pressed that they simply don't come to the office anymore until they are so sick they have no choice.

    So, yes; it saves some money up front. At the grim cost of widespread physical suffering, deferred care, greater risk of catastrophic outcomes, and almost surely higher costs to come.

    •  ^^ Important comment (14+ / 0-)

      about why the costs are coming down.

      PNHP has republished a NYTimes oped that  talks about the complexity of the act which is sure to bring down costs by keeping many from care...

      SNIP Posted on: Wednesday, November 20, 2013

      A Simpler, Better Solution

      By David Himmelstein and Steffie Woolhandler

      The New York Times, Room for Debate, May 29, 2013

      PNHP note: The following article by PNHP’s co-founders, while written in May, is still pertinent. For the most recent analysis, see our Articles of Interest, Dr. Don McCanne’s Quote of the Day, and the public radio commentaries of PNHP’s president, Dr. Andrew D. Coates.

      The Affordable Care Act is a giant workaround. Overwhelming evidence says that public insurers like Medicare (with overhead costs of 2 percent) are more efficient than private ones (overhead of private Medicare Advantage plans is 14 percent). And multiple insurers means multiple contracts, with varying coverage, billing procedures, documentation requirements, etc. – all of which force doctors and hospitals to waste billions more. The obvious fix is to cut out the insurance middlemen and cover everyone under a single public program paid for by taxes – with equal coverage for all. But the insurance lobby blocked that, so instead the Affordable Care Act took the Rube Goldberg route.
      In the exchange, “bronze” plans look cheapest – at first glance. But if your income is under 250 percent of poverty there are special discounts for copayments, but only in “silver” plans.

      Move from 400 percent of poverty to 401 percent, and individual premiums rise $2,303. Can’t quit smoking? Add $3,365.

      Stop paying your premium? You’ll stay enrolled for three months, but your insurer only has to pay your medical bills for one month.

      The health care law’s consumer protections apply to everyone, except the 58.5 percent of private sector workers whose employers self-insure.

      Employers who do not offer coverage must pay a fine, unless you work less than 30 hours a week, averaged over three months, or maybe 12 months.

      Small employers can get help with premiums, unless they buy coverage through a Taft-Hartley Fund.

      Got it? We don’t either. And there’s much more arcane detail that can mean life or death for thousands, penury or plenty for millions.

      Government already pays two-thirds of total health costs, but much of that money takes a detour through a maze of private insurers. This manufactured complexity sows confusion and adds huge expense – the cost of a workaround.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Fri Nov 29, 2013 at 06:14:48 AM PST

      [ Parent ]

    •  That's not caused by the ACA, is it? (0+ / 0-)

      That's the insurance corporations, who will not be able to do that in the future.

      Women create the entire labor force.
      Sympathy is the strongest instinct in human nature. - Charles Darwin

      by splashy on Fri Nov 29, 2013 at 09:56:50 AM PST

      [ Parent ]

      •  It's a complex interaction. (1+ / 0-)
        Recommended by:

        1) Many insurance companies are gouging the snot out of patients this year, because next year the ACA provisions limit their opportunities to do this.

        2) Many patients even under ACA will still be left with high deductible plans, which punish them with huge out of pocket costs for any care they receive until that deductible is met. I regard such plans as profoundly immoral because they very effectively ration care for poor, but not wealthy patients.

        3) To the extent that the ACA is an alternative to Medicare for all/single payer/public option, it facilitates and encourages just these kinds of abuses and gamesmanship. Does it save money? Yes. By explicitly making care unaffordable to individuals, it saves money at the cost of needless suffering and premature death.

    •  RAte increases have been falling for (0+ / 0-)

      a decade. The ACA seems to be a small. if any, player.

  •  Thanks nt (1+ / 0-)
    Recommended by:

    nosotros no somos estúpidos

    by a2nite on Fri Nov 29, 2013 at 05:46:30 AM PST

  •  And the effiiencies are only beginning (4+ / 0-)
    Recommended by:
    Rogneid, ybruti, saluda, a2nite

    A telling article in a NYT's Sunday mag article about how Bush's chief health guy, Thomas Scully, has launched a niche health care firm, Navicare, to tackle (and make a huge profit, he thinks) the costly post-discharge inefficiencies that beset health care.

    The stats driving Scully's decision to create Navicare: On average, Medicare's fee-for-service model pays for 2000 days in post-acute care facilities for every 1,000 beneficiaries. By comparison, Kaiser Permanente, a provider of low-cost quality care averages 600 days per 1,000 clients while achieving better outcomes.

    Crunching the numbers at face value, Medicare can be paying for an additional 70 million unnecessary days for its approximately 50 million enrollees. (Those days the post-discharge patient spends in Nursing Homes, or languishes in acute care beds.)

    Navicare, the article points out, will step into this piece of health care and provide acute providers with the necessary information and services to provide more efficient care for this slice of the Medicare population. Savings could be huge, with Navicare making a bundle.

  •  As someone who was very skeptical (4+ / 0-)
    Recommended by:
    steamed rice, Delevie, ccyd, rsmpdx

    of the possibility that the ACA as passed would do much if anything to curb costs, I'm pleased that so far I appear to have been wrong.

    I still think the single-payer "Medicare for all" approach would have been far, far better. But this is what we got so I'm rooting for yet more ongoing evidence I was wrong.

    "That capability at any time could be turned around on the American people and no American would have any privacy left, such is the capability to monitor everything ... There would be no place to hide." - Senator Frank Church

    by jrooth on Fri Nov 29, 2013 at 06:38:57 AM PST

  •  Anti-PPACA campaigns have pushed slogans (1+ / 0-)
    Recommended by:

    that play off the ideas of "government takeover" and such as "Death Panels."

    There's no more than a dozen popular anti-PPACA slogans. That's the reason you don't hear anything new from the GOPers.

    They plagiarize endlessly. Saves on having to think too much.

    We're not sure at this point how the anti-PPACA slogans match up with underlying hoaxes. That needs research.

    Hoaxes are defined by broad effects on their targets' world views, not simple misinformation.

    Political hoaxes are designed Ad Biz mechanisms that change how their targets perceive broad groups of other human beings, including "gubermint," our democracy itself.

    One category of hoax is called scapegoating. Blame job problems on illegal immigrants. Another ties an assertion of evil or criminality to a group: e.g., "Libruls are Baby Killers."

    The lies fuel the hoaxes. Hoaxes do the political heavy lifting. And using the word "myths" is usually incorrect diction -- the hoaxes are man made objects, not the result of innocent story telling.

  •  The financial story has been largely missed (5+ / 0-)

    except for a few excellent diaries such as the 4 part series by Fake Irishman.

    I remember too well all the fuss Romney exploited about how Obamacare was cutting Medicaid by $700 billion.  Romney always implied and counted on people interpreting that to mean Obama cut their Medicare benefits.  But many of us still miss part of the genius of the ACA related to that cut of funds in Medicare and that was how those funds got moved to the expansion of Medicaid and how that works.

    A key part of the Medicare funds that were cut were a chunk of the Disproportionate Hospital Share programs.  Those were funds that Medicare administered by sending to hospitals to help make up losses whenever they treated the uninsured. (These costs expanded quickly and by 1996 were about 10% of total Medicare costs.)   By diverting those funds to expanded Medicaid programs and subsidize Obamacare, the PPACA put power in the hands of the formerly non-insured and made them health service consumers.  It gave them choices which among other things gave them dignity and a better chance of getting treatment before problems became more severe and expensive to treat. It also altered how financial incentives work in the health care system, just as many other measures of PPACA did.

    1) healthier people due to more preventive care and early treatment
    2) better management of health costs due to less cost for the system downstream
    3) A little dignity for people who before were totally at the mercy of the system and now had some resources and availability of choices for their health care.

    And there you have Romney et al and their obtuse sense of privilege. Lie about how the funds will help people, how they help the system and tell people they can go to the ER.

    Unfortunately, there are two major health insurange programs now: Obamacare and Red State ACA. If you are unfortunate to live in a state with Red State ACA, you might miss out on expanded Medicaid because you are at the mercy of the real death panels.

    Obamacare restructured financial incentives in the healthcare service marketplace in a number of ways and we are just starting to see the benefits.   Read  McDonough's book Inside National Health Reform for more on this.

    I'm not liberal. I'm actually just anti-evil, OK? - Elon James White

    by Satya1 on Fri Nov 29, 2013 at 06:45:06 AM PST

  •  The threat of a Democratic President actually (1+ / 0-)
    Recommended by:

    doing something about the healthcare of fellow Americans certainly helps.

    Clinton tried but failed, but the opportunity to try again remained.

    GWB was no threat to the Medical-Industrial Complex.

    Obama actaully got reforms passed.

    Notice: This Comment © 2013 ROGNM UID 2547

    by ROGNM on Fri Nov 29, 2013 at 06:58:18 AM PST

  •  Agreed! (9+ / 0-)

    Turns out I'm eligible, because of my income, for Medicaid -- but the state I live in doesn't believe in accepting the Feds' assistance, so it may be months before I can actually GET on Medicaid. Even so, I'm signed up for a silver-level plan (for which I can probably get subsidies from a local effort that's the result of a major non-profit teaming up with a major health care provider) that saves me $200+ in monthly premiums over my current individual plan, AND saves me about $500 a month in prescription coverage. Any Republican opponent of the ACA who wants to tell me how bad "Obamacare" is had better be prepared to sit down and listen to ME tell THEM how much I prefer Obamacare to their system!

  •  maybe not... (2+ / 0-)
    Recommended by:
    divineorder, tofumagoo

    DakotabornKansan says:
    November 29, 2013 at 7:22 am

    Paul Krugman celebrates the slowdown in healthcare spending with his “Obamacare’s Secret Success.”

    “The “affordable” bit of The Affordable Care Act was also supposed to be about “bending the curve” – slowing the seemingly inexorable rise in health costs…Has the curve been bent? The answer, amazingly, is yes. In fact, the slowdown in health costs has been dramatic…”

    Krugman cites the report from the White House Council of Economic Advisers, chaired by Jason Furman, celebrating the fact that health care spending has finally come under control.

    [see “Why we shouldn’t be celebrating the slowdown in health care spending,” ]

    Krugman refuses to recognize that when people fear for their low paying jobs, they cut their medical expenses.

    “American workers are living with unprecedented economic anxiety, four years into a recovery that has left so many of them stuck in place. That anxiety is concentrated heavily among low-income workers such as Stewart…Job insecurities have always been higher among low-income Americans, but they typically rose and fell across all levels of the income ladder. Today, workers at the bottom have drifted away, occupying their own island of in­security.”

    Krugman also cites, “A less certain but likely source of savings involves changes in the way Medicare pays for services. The program now penalizes hospitals if many of their patients end up being readmitted soon after being released being released – an indicator of poor care – and readmission rates have, in fact fallen substantially.”

    Buried among the Obots praisings of Krugman, a reader’s comment from Boston:

    “The lower hospital admission rates would be unmitigated good news to me if I hadn’t read (in “Status of Medicare patients can result in huge bills” in the Boston Globe) about attempts to get around the readmission rules, apparently, by classifying a new hospitalization shortly after a previous one as something other than an admission – and leaving it to the patient to pay it out of pocket. I hope this is not a factor in the cost savings under discussion here, because then the cost savings would really be cost shiftings if patients are now bearing them instead of their insurance.”

    Liz Kowalczyk @ Boston Globe, “Status of Medicare patients can result in huge bills – Elderly patients hospitalized but not ‘admitted’ can face higher costs,”

    “Harold _ recently spent 10 days in a Boston teaching hospital, trying to snap back from complications after urgent hernia surgery. Nurses provided around-the-clock treatment, changing the 91-year-old’s catheter, for example, and pumping him with intravenous drugs for suspected pneumonia. It all seemed like textbook hospital care to his wife, Sylvia. So she was shocked to learn that Beth Israel Deaconess Medical Center had never “admitted” her husband at all.”

  •  "Oregon women, access to better health care" (6+ / 0-)

    Some good news about the ACA is starting to be heard, despite the din of criticism.

    Michele Stranger Hunter, executive director of NARAL Pro-Choice Oregon, writes in an oped in The Oregonian today.

    There is deep gratitude – and growing frustration -- among those of us who have spent years advocating for affordable health care for women. We are celebrating because 360,000 Oregon women are now benefiting from essential preventive care without the burden of co-pays, thanks to the Affordable Care Act. We are frustrated because this and other good news is being ignored in favor of political finger-pointing and stories about website challenges.

    We are thrilled that after just a few weeks there are already 10 percent fewer uninsured Oregonians. We are hearing from women how it is already making a difference in their lives, easing the all-too-common fear about not being able to afford health care for themselves and their families.

    Young women are celebrating that they can now get birth control with no co-pays. And women with pre-existing conditions—an abnormal Pap smear breast cancer or even pregnancy—can no longer be denied coverage and are breathing a huge sigh of relief.

    Women are celebrating. If they even know about these advances, that is.

    We are frustrated because the media’s focus is on canceled insurance plans. ...

    I can't help it. I love the state of Texas. It's a harmless perversion. - Molly Ivins

    by rsmpdx on Fri Nov 29, 2013 at 09:44:38 AM PST

  •  I'm glad Krugman is liked again at dKos (0+ / 0-)

    Back when this site went insane during the Obama vs. Clinton primaries in 2008, Krugman was excoriated here for making several pro-Clinton statements.

  •  as underwhelmed as i was by the Obamacare (2+ / 0-)
    Recommended by:
    BruceMcF, rsmpdx

    i figured it did a couple of useful things

    1) it clearly established healthcare to be a federal matter.

    2) it laid in baselines for electronic health records

    3) it established minimum floors on health insurance.

    i thought it might vaguely bend the cost curve,
    but it's apparently really bending the cost curve.

    if so, it must be truly driving the conservatives crazy.

    •  One thing to bear in mind ... (1+ / 0-)
      Recommended by:

      ... is that after decades of little or nothing in the way of putting the reigns on pricing of health care services ... there has been a massive amount of price gouging built into the system.

      That means that there is a lot of low hanging fruit for cost control measures to pick.

      Indeed, even if the health insurance companies and health care service providers get more leeway for profiteering through opening up loopholes in the system ... they still are not likely to be able to get to the extremes they had pushed to over the last decade.

      Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

      by BruceMcF on Fri Nov 29, 2013 at 11:43:10 AM PST

      [ Parent ]

  •  increases have been slowing for over a decade (0+ / 0-)

    in Health care spending. In 2002 the increase was up 9.7& over the previous year. in 2009 it was up 3.9% where it has remained. I do not see how that is the result of the ACA?

    Krugman uses a lot of assumptions about correlations that may or may bot be causal. But to say that a trend of lesser spending   that began 10 years ago is related to a bill assed in 2010 and not yet fully implemented seems overly simplistic if not impossible.

  •  I'm not so sure (0+ / 0-)

    about the slowdown. Are you sure it isn't a case of shuffling the deck. I went to the doctor recently. Paid my co-pay for his admittedly large fee, but then I got a bill for a room. So I inquired. It was a bill for using the exam room. I was... fairly astonished.


  •  I do not see how this could be lowering costs (0+ / 0-)

    Rates of increase were decreasing even more between 2002 and 2010. Recent reductions in increase have been more modest and actually stagnant for a few years. Selecting 2010 as a comparison year makes the implication that a a has caused a drastic reduction in health care spending. He knows better than that.

Andrew Lazarus, SME in Seattle, Pat K California, Thumb, dwellscho, Chi, True North, Odysseus, Subterranean, Shockwave, SanJoseLady, LEP, Carolina On My Mind, MarkInSanFran, Doctor Who, Wee Mama, sharman, ask, itskevin, jalbert, mollyd, splashy, revsue, Texknight, TexDem, crankypatriot, lcrp, ybruti, Sembtex, Leaves on the Current, Josiah Bartlett, Limelite, rapala, TexasTom, jrooth, ichibon, Tonedevil, OpherGopher, JohnB47, Sailorben, fixxit, eru, CompaniaHill, blue jersey mom, Rogneid, mightymouse, xaxnar, Dolphin99, hlee1169, Themistoclea, Kimball Cross, Dvalkure, global citizen, gpoutney, real world chick, OMwordTHRUdaFOG, CA Nana, doingbusinessas, ammasdarling, BeninSC, Habitat Vic, Loudoun County Dem, BruceMcF, puakev, yoduuuh do or do not, Mary Mike, AppleP, deepeco, leonard145b, janatallow, eyesoars, furiouschads, Ralphdog, TomP, gundyj, mconvente, GAS, OleHippieChick, elwior, monkeybrainpolitics, Calamity Jean, Lujane, tofumagoo, CitizenJoe, pelagicray, billybam, WearyIdealist, bleuet, rsmpdx, divineorder, indres, virginwoolf, petral, stevenwag, sfarkash, astral66, jpmassar, vtgal, The Jester, nsfbr, breathe67, LOrion, Betty Pinson, MsGrin, ericlewis0, TheHalfrican, kerflooey, BlueJessamine, BarackStarObama, VTCC73, Joe Jackson, DRo, anodnhajo, cwsmoke, We Won, ahumbleopinion, Mostel26, a2nite, gloriasb, hardart, MartyM, Jimmy D 84, doroma, Victim of Circumstance, hungeski, Sue B, Dallas L, aresea, Chas 981, Dodgerdog1, eagleray, patbahn, Sir Roderick, jrand, LarryLK, CJB2012

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site