Disclaimer: Mods, I’m not entirely sure this qualifies as a general question so if it doesn’t fit in here then feel free to move/close.
Anyway, I was just wondering if anybody knew of any fair, impartial, unbiased, warts 'n all appraisals of Obamacare. Everything I find on Google seems to be slanted one way or the other.
Cheers.
IMO your question is kind of impossible.
A theoretical “unbiased” source could say “*This *provision has *that *consequence”. And go on to say “Which in turn has this *other *consequence which in turn has …”
How many layers do you go before you’re biased? Or are you biased if you don’t follow every rabbit-trail to the bitterest end? Recognizing that at every layer, including the first, there’s an element of simplification and assumption in what really are the consequences. Human society is much more like an Ouija board where things move as the mysterious total result of hundreds of interlocking factors, than it is like a Tinkertoy machine where pushing on *this *lever 2" moves that spool 4".
Let’s take a simple and fairly uncontroversial fact: “10 million people got health insurance that didn’t used to have it.” Let me be clear that the specific number 10 million is a number I just made up, but is not a crazy number. How would we even in principle count the actual number? We can’t. So we have to estimate based on assumptions. Which assumptions are “unbiased”?
Once we get past that, and magically have our unbiased number what’s next? We have to decide if that represents something good and beneficial or something bad and harmful.
“More people having insurance” sounds at first glance like an unvarnished good. But inextricably connected to it are effects like increased use of medical man hours and facilities, increased total spending, different distributions of who pays what for what, etc. How do we score the goodness or badness of each of those things?
All these quibbles are not unique to evaluating Obamacare or even the medical industry. Evaluating any other complex activity, be it corporate or governmental has all these challenges.
You’re not going to find unbiased. What you can hope to find is facts that are actual facts borne out by actual research and verifiable statistics versus those just made up on the spot with no regard for the truth simply to support a POV. As well you can look for more complete info vice selective reporting.
Kaiser Family Foundation is a great starting point, and very reader-friendly. Health Reform | KFF
One thing that’s really important to note about any discussion of the ACA: Those who work in health policy are going to spend less time talking about whether the ACA is good policy in general, and more time talking about specifics.
There is no way to do “an appraisal” of the ACA. The above link will have lots of information on consumer impacts of the ACA, but that’s not really even the biggest thing the ACA is doing. It’s a huge thing that is impacting every single level of health care in the US. Most readers are not going to be comfortable delving into the depths of Alternative Payment Models and Health System Transformation, but there is no way to assess the ACA without discussing those things.
In addition to the KFF, I have found the writings of Saraf Kliff at VOX to be pretty fair and balanced.
If we believe that the health care system before the ACA was the single most expensive way to pay … then the ACA has saved money, by default …
I’m a fan of ACA (warts and all) but IMO that’s not necessarily true.
We may be spending more total money under ACA but also getting more total care. Which might or might not be more or less per capita. Which number is the relevant one? Darn good question.
A reasonably fair assessment is that the ACA expanded insurance coverage without doing much to reign in costs.
I think this is a fair assessment.
Here’s a perspective from someone who’s British - i.e. I have experience of a quite different system (with it’s own problems, but they are different problems) and none of the partisan political baggage surrounding the issue in the US:
ACA is going in the right direction, but there are two fundamental flaws in it:
(1) The whole basis of insurance is that everyone who’s in a prior position of similar risk pays modest amounts into a pool, then the pool is used to pay out large sums to help the few who are later unlucky. But since the insurers are now prohibited from differentiating known risks (health profile, pre-existing conditions, etc), what’s happening is that all risky people are buying insurance (that the insurers are obliged to provide) while many healthy poor people are not. Paying into the insurance pool must be mandatory for everyone, which ACA has made only half-hearted efforts to do. By far the simplest way to make insurance mandatory for everyone is simply to fund all healthcare out of general taxation - which is the approach used in (so far as I know) every other developed nation in the world.
(2) Costs remain out of control. The supposed benefit of the U.S. system is that you have free-market price competition. But there is zero market transparency, so clearly this is an utterly dysfunctional market. When I moved to the US (pre ACA) I considered not insuring, on the basis that maybe I could just go back to the UK if (say) I got cancer or needed a transplant; and I could just pay routine costs myself. It’s completely unworkable, because nobody can tell you what anything is going to cost beforehand, and there’s this bizarre game where healthcare providers make out bills for (literally) 500% more than they actually charge insurance companies, so unless you’re working through an insurance company that has pre-negotiated rates, you’re screwed. The solution to this and many other cost control issues is, of course, single payer.
The bottom line is that the U.S. needs a nationalized healthcare service like the UK or Canada, or virtually every other developed nation in the world. It’s not a partisan party-political issue, it’s not a right-wing left-wing thing, it’s just the only thing that works well to provide the fundamental human right to healthcare. And I tend to think that it’s the system everyone would favor under a Rawlsian veil of ignorance.
I predict that single payer will happen eventually, not by anyone winning the political battle, more likely by one major state implementing a system at a state level and showing that it works well.
Don’t Oregon, Hawaii, and Massachusetts already have something like that? How are their systems working out?
(I fear that “eventually” may be a long way off, as a significant portion of the U.S. population has conniption fits at the mere thought of anything tainted with the label of “socialism.”)
No states have single payer yet. Colorado has a vote on tuesday to create a single payer system, but I don’t know if it’ll pass. Even if it does, maybe they will do what Vermont did and back out.
MA has a system like Obamacare. Hawaii has laws mandating employer coverage and Oregon tried to pass single payer in 2002 and failed.