An architect of the law reflects on its surprises and its future.
Insurance premiums on the exchanges have also surprised me -- but
not in the way that most readers would think. Most press coverage
recently has focused on the high premium increases in exchange plans,
and the exits of some insurers losing money on the exchanges, notably
United Healthcare. But what those articles tend to ignore is that
exchange premiums in 2014 came in much lower than expectations --
about 15 percent below what CBO projected. So even with recent
increases, premiums are probably still lower than what would have
been expected before the exchanges began. That gets overlooked.
...
Employer-sponsored insurance was slowly declining before the ACA,
and I expect that it will continue to slowly decline. But there
is no evidence that the ACA is leading to its collapse. We see no large
shift in the preferred mode of health care coverage for employees.
...
The recent rise simply reflects a "catching up" after insurers
initially set prices too low. After a few years of large premium
increases, premium growth rates should settle back down to keep pace
with the growth in health care spending.
...
The fact is that exchanges in every state are well above the
minimum scale required to function effectively. And the fear of
"death spirals" from rapidly rising premiums is greatly exaggerated
when the vast majority of exchange enrollees are subsidized, meaning
they don't pay those higher premiums. This provides a stable base
of enrollees, even as premiums rise.
Paul Krugman, January 28, 2016
To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich -- and single-payer really does save money, whereas there's no evidence that tax cuts deliver growth. Still, it's not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.
Life expectancy and infant mortality are wholly inadequate comparative measures for health care systems. Life expectancy is influenced by a host of factors other than a health care system, while infant mortality is measured inconsistently across nations. Neither of these measures provides the United States with conclusive guidance on health care policy, let alone serve as reliable evidence that a system of universal health care "should be implemented in the United States."
Online print debate between Bloomberg view columnists Megan McArdle & Leonid Bershidsky about single-payer health care in the U.S.
MM: We might like an American government that was better at technocracy (or we might not), but we don't have one. We have instead a messy, fractious democracy that offers interest groups almost unlimited veto points against legislation they don't like. Love it or hate it, these forces make our government extremely bad at controlling costs, which shows up not just in our health-care and education systems, but also in the price of building our infrastructure or providing various social services.
Megan McArdle, April 30, 2014
The financing is impossible, in part because the politics is impossible. And the politics is impossible in part because the financial hit would be too big. Single-payer would have to be paid for at the extremely high prices that Americans pay, not the lower European prices that we'd rather have. And when you look at the taxes needed to finance a government takeover, you quickly realize that most people just aren't willing to pay the price