You can see what's good about it just by looking at things that are
already happening.
Quality is on the rise:
Obamacare Shows Hospital Savings as Patients Make Gains
Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law.
While much of the focus on Obamacare has been on the government rush to open insurance exchanges by Oct. 1, 252 hospitals and physician groups across the U.S. have signed up to join the administration’s accountable care program, in which they share the financial risk of keeping patients healthy.
Under the program, hospitals and physician practices take responsibility for tracking and maintaining the health of elderly and disabled patients. If costs rise beyond an agreed upon level, hospitals may become responsible for reimbursing the government. If they cut the cost of care while maintaining quality, hospitals share in the savings. The government expects the savings may be as much as $1.9 billion from 2012 to 2015. Early indications suggest they are starting to add up.
In other areas where the ACA's quality improvement provisions have launched, they're starting to show some results. For instance,
unnecessary hospital readmissions are dropping and the Medicare Advantage quality bonus program is
working (incidentally, contrary to speculation a few years ago that Obamacare would destroy Medicare Advantage, enrollment in that privatized bit of Medicare this year is
at an all time high):
This year [2012] we saw significant improvement in measures included in the Medicare Star rating pay-for-performance program for health plans that participate in Medicare Advantage. Although Medicare Advantage plans have reported on quality and results have been reported to consumers for many years, the Affordable Care Act required the Medicare program to make higher payments to health plans with better quality performance, starting in 2012. In addition to this new program, the Department of Health and Human Services established a demonstration program to complement it, making even higher payments to plans with better performance.
Competition is growing:
Health Law Is Fostering Competition, U.S. Says
This, of course, isn't just true of the marketplaces being run by the federal government, but of those being run by states, as well.
Two Oregon insurers rethink 2014 premiums as state posts first-ever rate comparison
Costs are currently in check--and there are some glimmers of hope that this can persist:
To go with the news that we're enjoying the
slowest health care price inflation and the
lowest group health insurance premium increases since the late '90s, as well as the
slowest health spending growth and the
slowest per beneficiary Medicare cost growth ever recorded, next year's exchange premium numbers have been trickling out for the past month or so and the news is generally good.
In some states, costs for a standardized set of benefits is actually going to be
lower next year than they cost this year (in comparison to the small group market, where comparable protections and benefits exist today), suggesting that competitive insurance markets can actually work.
States like Washington:
Premiums drop, coverage expands in Washington's exchange.
And Montana.
Insurance commissioner: Price of policies offered on `Obamacare’ exchange in Montana relatively less expensive
In fact, premiums for next year have been coming in lower than expected in
states across the country. In
Oregon. And
California. And
D.C. And
Colorado. And
Vermont. Competitive marketplaces are good.
Capacity to meet folks' needs is growing:
We're seeing big investments in
construction and renovation of community health centers in underserved areas (even anti-ACA GOP Congressfolks have
caught heat recently for taking advantage--rightly, I think!--of Obamacare's investment in new health centers) and indications that
retail medical clinic capacity is going to double over the next three years.
Last fall saw
more medical school applicants than ever:
A record number of students applied to medical school in 2012 according to new data from the Association of American Medical Colleges. Applications have risen over the past decade, growing more quickly over the past few years than they did in the mid-2000s.
This year will see more folks being trained to become doctors than ever before: the residency match that just took place a few weeks ago saw
more matches and a record-high match rate:
The 2013 residency program match hit an all-time high of more than 29,000 positions due to a new "all-in" policy that requires programs to register all their available slots, according to final data from the National Resident Matching Program (NRMP).
The 29,171 positions offered in 2013 marked a 9% increase from the 26,772 offered the year before, and 96.4% were filled -- resulting in the "highest fill rate in NRMP history," with match rates rising for "nearly every applicant group," Mona Signer, executive director of NRMP, said in a statement.
If you want to know what's good about the ACA, recall what's been bad about our system for a long time. Insurance markets have been broken and anticompetitive all around the country. Our public health infrastructure and our workforce have been struggling to keep pace with the demands of the 21st century all around the country. Our health care delivery systems have been underperforming on efficiency, quality, safety, you name it all around the country. People are strapped by medical bills and rising insurance costs all around the country.
These things are finally getting the attention they deserve and the reforms and investments they need to change and thrive. The good stuff above is just the beginning. There's still a very long way to go but for the first time, perhaps ever, this country is putting a foundation in place on which to build a health system that works better, serves all, and does it without unsustainable spending growth. That's very good and if we commit to success it's only going to get better.