Tuesday, March 27, 2012

Affordable Care Act

I have not commented on the Affordable Care Act in a while.  With the Supreme Court case right now, I think it is worth commenting on again.

  • Yesterday, I saw a public radio program's site asking for comments on mandated health care.  First things first--no one is mandating health care.  What is being mandated if it is considered constitutional is health insurance--that is not the same as health care.
  • Just because people have health insurance doesn't mean that they will use care or use it to achieve any higher quality of health care services than they are now.  Yes, they will have reduced financial barriers.  But there are many more barriers that are non-financial.  Anyone who has ever wanted to see a new physician for a non-emergency reason has probably experienced a long wait.  For some people that is not a problem. For others, it might discourage them from seeking care.  And even if a person gets more care it doesn't inherently mean that it will be any more coordinated.
  • While there are non-financial barriers, empirical research suggests that people who pay less for care when they need to use it use MORE care.  (In other words, medical care follows the same response to price that almost everything else does.)  Are there some people who will use less care or at least less expensive care because they get preventive care or have a chronic condition managed better and stay out of the hospital?  Of course.  But, at a population level it is quite possible that making care less expensive at the time people need it will end up leading to spending more on health care rather than less.
  • I realize that people with pre-existing conditions would like to not have to worry about financing their health care expenditures.  That is true of all of us.  If insurers are no longer allowed to restrict the enrollment of people with pre-existing conditions, individuals with pre-existing conditions will be able to get financial protection that they could not get before. What will that do to premiums?  When individuals who are expected to spend more are added to the risk pool, the premiums will necessarily go up.  Now, that may be offset by health care providers not needing to charge some extra to make up for uninsured individuals, but there is no guarantee.
  • Finally, with many more people with insurance who wish to consume a greater quantity of care, that will put more pressure on an already crowded health care system.  Without an increase in care providers, the waits that we already experience will grow longer.
So, is the net result good, bad, or otherwise?  Some people will obtain financial protection who did not have it before.  I am glad that is the case.  If they pay for it directly that will shift at least some of the financial responsibility for care.  There is an argument for fairness in that.  However, there is no guarantee that overall we will pay less as a society, that individuals with insurance will pay lower premiums, or that anyone will get higher quality care in a more timely way than we are now.  


  1. sound perspective and commentary, Kevin. Having reviewed heart of both Senate and House bills, flaws and short sightedness would be understatements. Quite a redistributive bill is all not centered on healthcare rather access as you cited. To worsen picture longterm, they are not calculating mass exodus and attrition of providers outside hospital systems and lowering standards of med school in longterm to attract from fleeing students. Too much to say from reports of court's reported logic so early in arguments.

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  3. Thanks for your perspective Dr H. Real reform would try to find a way to improve care and make care more accessible. I don't know that anything we have seen in quite a while would provide incentives for that.