We Don't Know if Obamacare Is Working Well. But We Know It's Working

[babylonsister]

http://www.newrepublic.com/article/116061/obamacare-enrollment-surges-more-1m-sign-thru-healthcaregov

We Don't Know if Obamacare Is Working Well. But We Know It's Working

BY JONATHAN COHN


snip//


We know, first and foremost, that healthcare.gov is a (mostly) functioning website. This was no sure thing even a few weeks ago. At the end of November, when officials announced that they had met their goal of constructing a website that worked well for most customers, they were cautious to warn about future problems. Partly that was because their previous predictions of success proved so unbelievably wrong. And partly that was because they feared a late surge of customers would overwhelm the site’s capacity, threatening a whole new period of chaos. But the system held up just fine, as the high enrollment numbers indicate.

More important, we know that many of the people getting insurance are very, very happy to have it. In the fall, when insurers began sending notices of rate increases and plan cancellations, all we heard about was people unhappy with—and in many cases angry about—their new options. Now, however, we are increasingly hearing stories about people who are saving money and, in some cases, getting access to health care they’ve desperately needed for a long time.

Here two examples, culled from a new story by Lena Sun and Amy Goldstein in the Washington Post:

Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. And he’s looking forward to running a marathon in mid-January along the California coast without constant anxiety about what might happen if he gets injured.

These plans are possible, says Peterson, who turned 50 this year and co-manages a financial services firm in Champaign, Ill., because of a piece of plastic the size of a credit card that arrived in the mail the other day: a health insurance card. …

Dan Munstock knows this. A 62-year-old retiree in Greenville, Tenn., he hasn’t had insurance since he left his job as a crisis counselor in Miami six years ago. He lives on Social Security income of less than $15,000 a year. Although he does not know of any major ailments, he would like a checkup because, he said, “you can seem fine until the day you drop over with something.”

Like thousands of other Americans, Munstock ran into technical problems with the federal Web site before managing to pick a health plan Dec. 1. He qualified for a federal subsidy to help him afford the insurance, so he has to pay just $87.57 a month toward his premium. After his welcome packet from Blue Cross Blue Shield of Tennessee arrived in the mail, Munstock was so eager to finish the process of enrolling and getting an insurance card that he picked up the phone to pay the first premium instead of using the mail.

“It felt really good,” he said. Paying toward his own insurance, he said, gives him “a certain dignity,” a feeling that he is not “one of the takers.” The next day, he called the doctor’s office. His appointment for a physical is Jan. 2. …

Like the stories of rate hikes and plan cancellations, anecdotes of people gaining insurance or saving money will frequently prove more complicated than they seem at first blush. Some people will discover they owe more out-of-pocket costs than they imagined, because of high deductibles and co-payments. Some won’t be able to see the doctors they want, because plans have limited networks of providers. Some will haggle with insurers over particular bills or services. And that’s not to mention the many other trade-offs in the law—like higher taxes on the wealthy, cuts to various industry groups, higher premiums for some people buying their own coverage, and other steps that made possible the law’s expansion of health insurance.

But nobody ever promised that Obamacare would solve all of the health care system’s ills—or that it would come without costs of its own. The goal has always been to make insurance more widely available, so that more people had access to care and protection from crippling medical bills, while beginning the difficult work of reengineering medical care to make it more efficient. The new enrollment numbers should give us new reason to think it will.

[MADem]

1. ...access to care and protection from crippling medical bills...

Yes indeed.

I believe the road to single payer runs through Obamacare.

[Drew2510]

3. I agree

and it will most likely happen when the full extent of the costs become known in a few years. I'm certainly not wishing for it, but I predict the cost of the subsidies will be overwhelming and unsupportable. When people wake up to the fact that billions & billions of their tax dollars are going to private insurance companies (a bail out IMHO) they will start to scream.

[MADem]

4. I think the costs NOW are insane, and ACA is going to bring them down.

When people realize that there's strength in numbers, there will be more call for a system where we all band together as one. The next logical step is single payer. The challenge is getting the Greedy Gus's outta the way.

[Drew2510]

5. Well I certainly hope in the end

that what you say will be fact. But, I'm curious. When you say the ACA is bring down the costs, do you mean the true overall cost of the med bills themselves, or just the costs that the people/patients will be responsible for? I see no evidence so far, that the costs of the actual care itself is coming down, do you?

[MADem]

6. Here's some evidence for you.

Have a look at this article -- it might help your understanding.

Starting in 2010, the ACA lowered the annual increases that Medicare pays to hospitals, home health agencies and private insurance plans. Together, these account for 5 percent of the post-2010 cost slowdown. Medicare payment changes always provoke fears — in this case, that private plans would flee the program and that the quality of care in hospitals would suffer. Neither of these fears has materialized, however. Enrollment in private plans is up since the ACA changes.

The law also emphasized that payments should be based on the value, not the volume, of medical care. In a value-based system, compensation is made for the patient as a whole, not for specific services provided. As a result, eliminating services that are not needed is financially rewarded. The reaction to this change has been rapid: Hospital readmissions, which used to bring in substantial dollars, are now penalized.

....The accountable-care movement — which aims to make providers more accountable for the cost and quality of care — has blossomed far beyond expectations. There are nearly 500 Accountable Care Organizations (ACOs) nationwide, half in Medicare. Ten percent of Medicare beneficiaries are in ACOs, and many others are in payment systems that put together all reimbursements for a procedure, such as a hip replacement or cardiac stent insertion. Leaders of medical systems routinely report that they expect, and are preparing for, a move to value-based payments.

Evaluations of recent ACO programs show quality improvements among all participating organizations and financial savings for many. This is not a surprise. The Institute of Medicine has been reporting for more than a decade that a third or more of medical spending could be eliminated while increasing patient health. The only surprise is how fast the system has moved in this direction.

The right wing, desperate to try to derail the inevitability that is the ACA, and to halt any march towards single-payer, is shopping a theme of desperation that revolves around costs going up, but it's just not true. Costs are going down, hospitals are forced to economize, they can't charge fifty bucks for an aspirin anymore, and the more they try to milk the system, the more they are penalized.

You'll notice that all the "Sky is falling" themes are coming out of FauxSnooze and other crappy sites like "Town Hall" and Forbes and Washington Times and Breitbart and the Daily Caller--all virulent wingnut websites that wouldn't know truth if it bit them in the ass.

[tabasco]

2. If the pukes and baggers are squealing,

it's working just fine.