[The potential problem for the Democrats will be that most of Obamacare will still be only the promises you list, even five years after it will have been passed.
I'm not sure what that means. People have already seen changes: the elimination of lifetime and annual caps, the extension of coverage for dependents, and the rest of the new Patients' Bill of Rights. Lives have already been saved by the temporary pre-existing condition pools. Starting this October, millions of people who previously couldn't afford coverage or were discriminated against in the underwriting process can start shopping for coverage. They'll do it in real, transparent marketplaces. Those are real changes to the insurance market and millions have been or will be helped by them.
On the care front, we've already seen hundreds of provider organizations and groups volunteering to be
held accountable for holding costs down and improving quality under Medicare's initiatives, we've seen hospitals starting to change the way they deliver care and
building connections with community resources to make sure Medicare patients don't relapse after discharge. We're seeing partnerships between the public and private sectors to support innovations in primary care that we know are necessary, especially for the most expensive patients. We're seeing almost every kind of improvement to care delivery you can imagine
being tested, with half the states being funded to work on their own initiatives to build partnerships with private sector partners to improve care delivery and slow cost growth. We've seen states taking advantage of new options to offer better care for the most complex and costly Medicaid enrollees.
It would take all day to list all the promising changes we're seeing (if we care to look). But you want to talk about the politics, not the policy. People want to talk dollars. Well, what are we seeing? We're seeing the
slowest health care price inflation since 1998 (virtually the only time in the last half century that the cost curve actually bent). We've seen the
slowest growth health spending growth in the 52 years that data has been tracked. We saw the
lowest group premium increases last year since, again, 1998 according to Mercer. We've seen literally
hundreds of billions of dollars of Medicare and Medicaid obligations melt away over the next few years as health cost growth has slowed--Medicare per beneficiary cost growth last year was
nearly zero. The slowdown has been so sustained and far-reaching that nearly every observer has started talking about the "structural" component to it--in other words, reforms in care delivery.
This is
at the same time that we've seen existing private coverage improve, existing Medicare benefits expanded, early expansions of Medicaid in multiple states, investments in health care workforce development and public health, and more. The reality is that it's the reforms that aren't sexy and don't get the headlines that have the potential to save us (nice as the coverage component of the law is). And those are ongoing.
Does expanding coverage, controlling costs, and improving quality sell politically, even if the mechanisms behind them are largely unknown to Joe Q. Public? I hope so. Otherwise our health sector is doomed to a rather unpleasant and unfortunate fate. As are all of us.
