The plan as suppose to:
1. Lower costs. Not happening.
2. Insure more people. Hurting 1,000,000 in just one section of the bill.
3. Create a quality system. Instead we will get rationing.
The cost control aspect of the law is a long-term process based mostly on testing numerous delivery system reforms and, after demonstrating their cost control potential, implementing them on a wider scale. That's going to take time.
Jonathan Gruber had a good piece on the
NEJM website not too long ago that addressed some of this: "The Cost Implications of Health Care Reform" (I'd link but apparently my post count isn't high enough).
Yet the real question concerns how far the ACA will go in slowing cost growth. There is great uncertainty, mostly because there is such uncertainty in general about how to control the rate of growth in health care costs. There is no shortage of good ideas for ways of doing so, ranging from reducing consumer demand for health care services, to reducing payments to health care providers, to reorganizing the payment for and delivery of care, to promoting cost-effectiveness standards in care delivery, to reducing pressure from the threat of medical malpractice claims. There is, however, a shortage of evidence regarding which approaches will actually work — and therefore no consensus on which path is best to follow.
Given this uncertainty, it is best to cautiously pursue many different approaches toward cost control and study them to see which ones work best. That is exactly the approach taken in the ACA, which includes provisions to reduce consumer demand through the Cadillac tax, to reduce provider payments by appointing a depoliticized board to make up-or-down recommendations to Congress on changes to MedicareÂ’s provider payments, to run dozens of pilots to test various approaches to revamping provider-payment incentives and organizational structure, to invest hundreds of millions of dollars in new comparative-effectiveness research, and to launch pilot programs to assess the impact of various reorganizations of the medical malpractice process. None of these is guaranteed to work, but together they represent a significant step toward fundamental cost control.
In the same vein, Peter Orszag and Ezekial Emmanuel had a piece in the
NEJM this week ("Health Care Reform and Cost Control") walking through some of those reforms in a bit more detail.
As for coverage, I don't think even the most vocal critics have disputed that this law is going to result in coverage for millions of people who don't currently have it.
And quality is intimately related with the delivery system reforms I just mentioned. It involves paying for quality, fostering the use of EHRs, identifying the most effective treatments, coordinating care, re-aligning incentives, and so on. Those are the things that have the potential to make a massively inefficient system work better--not only will that improve quality, it will (one hopes) in the long-run lower costs.