Let’s stipulate that the US health care “system” was and is a mess. Our costs are about twice as high as other industrialized countries’, outcomes are not as good, and for consumers and purchasers, it is confusing as hell.
The question is, is PPACA making it better?
There’s no question the PPACA has a lot of flaws, several of which are being used for a series of legal challenges. There’s a reason for that; PPACA wasn’t supposed to be the be-all and end-all bill.
The legislation that was eventually passed originated in the House, and it was only passed “as is” because Scott Brown won the Massachusetts Senate election and his seating forced passage of the House bill by the Senate. (Brown’s election gave the GOP 41 seats, allowing for a filibuster)
I won’t get deeper into the political history of PPACA passage; wikipedia has a very good synopsis for those interested in more history. The net is, PPACA is here. It is not going away. And there are no alternatives out there that make any sense and/or have any chance of passage and adoption.
So PPACA has a lot of warts – so does pretty much every Congressional legislation. We may not like it, it may drive us nuts, but it’s reality. Our legislative process is sausage-making at its finest. Or worst, depending on your perspective.
Pre-PPACA, our health care “system” was hurting our international competitiveness, driving up the Federal deficit and state and local expenditures, covering fewer and fewer people, and delivering lousy care to a large part of the US population. Now, several years into passage, we’re starting to see indicators PPACA is having the desired effect.
Medical inflation remains relatively low. I, and others, would argue that is in large part because of the systemic changes driven by PPACA.
- last year health care spending grew 3.6% – the lowest rate since 1960.
- over the last four years, health care inflation has tracked GDP growth – compared to prior years when it was consistently higher than the GDP growth rate.
- the system is getting better – serious medical errors declined by 17% between 2010 and 2013 – saving about $12 billion.
- Medicare inflation is flat. In fact, CBO projections for Medicare expenditures in 2019 have dropped by $95 billion over the last four years. As Medicare utilization isn’t really affected by the economy, that’s a pretty solid indicator that the program is more sustainable than we thought just a few years ago.
- Medicaid costs are up – as we’d expect them to be.
Overall, things are improving, rather dramatically - but not without pain. Narrow networks, lower earnings for some doctors, higher insurance costs for some employers and consumers, a financial squeeze for many hospitals, all are real and painful.
What does this mean for you?
Fixing very big problems is ugly, thankless, and rife with collateral damage. It’s also absolutely necessary.