Megan McArdle lists eleven “talking points repeated as if they’re facts” and attempts to explain the factors behind them. Are they correct or incorrect? No one knows for sure but they are not facts. They are either predictions or opinions with more or less basis. Here they are:
- Once Obamacare goes into effect, it will be impossible to substantially cut it back.
- Accountable Care Organizations are certain to bring down overall health spending.
- Obamacare works because it gets money from deadbeats who go to the emergency room and then stiff the rest of us for the cost.
- Emergency room use will decline.
- People can game the system by going without insurance and then buying it when they get sick.
- Breaking the link between health insurance and employment will spur entrepreneurship.
- Obamacare will reduce the budget deficit.
- The Independent Payment Advisory Board is going to radically change the relationship between you and your doctor.
- People with pre-existing conditions will be able to buy insurance in the private market for the first time.
- Obamacare will bend the cost curve.
- Obamacare will make bankruptcy a thing of the past, at least for the people who gain coverage.
Some of these are likely, some are possible, some are unlikely. I don’t think that any of them is impossible.
This might be a good time for me to remind people of my views on the PPACA: I think it’s inadequate and will mostly serve to kick the can down the road. However, my objectives are very different from those of most people—I think that we need to constrain the increase in healthcare spending to the increases in costs in the non-healthcare part of the economy.
I’m occasionally taken to task for not rejoicing in this or that new development in the healthcare system. That’s easy to explain. I don’t care that premiums in the exchanges won’t be as high as some of the PPACA’s opponents were predicting. I never predicted one way or another and that’s just a test of predictions rather than a test of the program. I don’t care that healthcare spending is only increasing four times as fast as increases in the non-healthcare parts of the economy rather than six times as fast as it was just a few years ago—it’s still increasing far too fast, unaffordably high. And nobody really knows why that is.
I do agree with this observation of Megan’s:
The consensus about Obamacare among health economists is narrower than the range of opinion among the broader community of public intellectuals, and much narrower than that in the general public. Mostly the experts think that it will be good for the individuals it covers, but that the other beneficial effects promised — such as bending the cost curve — aren’t particularly likely. Increasing the demand for a service does not usually drive the price of that service down, especially when supply is constrained, as the supply of doctors is in the U.S.
I don’t really see how we can constrain the supply of healthcare as we do in the United States, increase the demand of healthcare as has been the case even without the PPACA which, if it functions perfectly, will further increase the demand for healthcare, and still reduce costs as I think the sine qua non of healthcare reform must be.