In spite of my broader liberal leanings, I was a critic of the ACA when it was coming out. One reason was the moral hazard of the individual mandate (I did not like this), but the other primary reason was that it didn't do enough to keep overall spending (total national spending, not subsidized cost to individual) under control.

The data for the majority of the probable political lifespan of the ACA is now available. The numbers make me wonder - did this legislation do anything for affordability of health care? It did get more people covered and vastly simplified the process of getting covered. Those were great accomplishments (which are about to be completely reversed), they were good for our nation, and I want to recognize that.

http://www.ncsl.org/research/health/health-insurance-premiums.aspx



I realize that the Republican replacement is going to be vastly worse. In defense of the ACA, in 2015 we spent 17.9% of GDP on health care, and has been a little constant-ish since 2010. This is possible largely because US GDP growth, itself, was relatively strong during this time as well. These healthcare cost increases numbers tend to be nominal figures, so a GDP real growth of 2% would actually counter-balance something more like 4%, and a 5% healthcare growth would only be 1% increase in the GDP burden to the national economy at-large.

https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html

But real life doesn't work on an economy-at-large scale. While GDP has been growth, incomes have still been relatively constant, and those individual income figures have been directly absorbing the healthcare cost increases, outright displacing other spending and savings.

Now, in 2017, we are faced with numbers like seen in the following article, which come close to apocalyptic.

https://www.vox.com/2017/5/30/15701986/blue-cross-north-carolina-obamacare-premiums

Quote :

"Wilson would have filed an 8.8 percent rate hike if he knew those funds would be paid. But he bumped it up to a 22.9 percent increase because he doesn’t think the Trump administration will come through."

How is this okay? How is even the baseline okay? How ridiculous is it to essentially say "remember that old system that only caused 8.8% year-on-year cost increase?"

The 8.8% number would not have been okay. That's horrifying, particularly because this sector has not seen any years in recent memory where cost increases were lower than wage increase (not even close for a cherry-picked second) to offset. In terms of gross numbers, we have surpassed spending of $10k per person of health care spending against a $56.5k median income. I can't express how not-okay this is.

Numbers approaching a 1/3rd one-time increase strike me as foretelling an imminent collapse. We were not starting from a sustainable footing.

So, the only question we have left to ask is "where is the self-correction?" Calling something unsustainable just means that it will transition to something else after the crisis point is hit. The Republican guiding-principle has largely been to reduce federal spending obligations in return for a larger number of millions of people going uninsured. If insuring fewer people reduced total national spending, this would be coherent. However, this brings us right back to the pre-ACA discussion and the conclusion that "it won't". In many ways, denying care can come back and bite the system in the form of ER visits, etc.

Homeless people are expensive to society. People in jail are outrageously expensive. The growing class of the working poor are not going to be good for national economic health either.

The primary cost drivers aren't even the cost of care anymore. The US is only truly unique in administrative burden in the healthcare sector, and this is not explainable as anything other than mismanagement. It's not just the healthcare functions of society, but the entire economy that will suffer the eventual blow from this.

6/4/2017 10:38:03 AM

Quote :

"How is this okay? How is even the baseline okay? How ridiculous is it to essentially say "remember that old system that only caused 8.8% year-on-year cost increase?" "

It's OK because the old system hid how much we were spending on healthcare. Take away the subsidies and look at the true price of health care, and then we may be able to have an honest discussion about why medical costs are so high and have no transparency.

6/4/2017 6:48:05 PM