Saturday, November 15, 2014

"Obamacare: Reducing the First Derivative of the Health Care Cost Curve!"

"Reducing the First Derivative of the Health Care Cost Curve" -- it's practically bumper sticker-worthy, right?

Well, maybe not. But it was what I thought when I read an article in Think Progress yesterday, "Obamacare Premiums To Increase By Less Than 4 Percent On Average."

According to the Center for American Progress, premium rates for the individual market in states with federally-facilitated marketplaces will rise by an average of 3.9% next year. For silver plans, the increase will be lower: 3.45% on average.

This is a significant improvement on the status quo ante; as the article points out, from 2008 to 2010, the average premium rate increase was 10.9%.

Viewed from the perspective of a technocrat or policy wonk, this is clearly a success: you are "bending the cost curve." Although the cost continues to go up, you have controlled its rate of escalation. The slope of the curve is getting smaller.

However, many people will not view the rate increase with the eye of a technocratic manager or market-fetishizing policy wonk. The 3.9% increase is just that: an increase. It is less money in your pocket.

And those rising rates are being accompanied by stagnant wages for most Americans. As of last year, 95% of income gains since the recession had gone to the top 1%. Many people have yet to feel the recovery that gets talked about on the news.

And therein lies one of the political failures of the Affordable Care Act. When people see their rates go up, their first instinct may be to blame the Affordable Care Act. (Framing in news stories doesn't help.) However, the fault lies not in what the ACA did--it lies in what the ACA didn't do, (namely, provide high-quality health coverage to all as a public good or a right). And that's a distinction that can often get lost.

Celebrating a 3.9% increase in health insurance premiums as a success because it is better than the much higher increase in the alternate reality version of 2014/2015--that without the ACA--makes one sound very removed from the experience of those struggling to get by. You're saying, "You have less money, but at least it's more than you would have had otherwise!" That's just not compelling.

Democrats often have a habit of underselling and overselling the Affordable Care Act at the same time. They undersell it by not talking enough about (or campaigning for) the most successful part--the Medicaid expansion---or explaining the many seemingly small yet very meaningful measures included to improve public health. And they oversell it by acting as though it made health care a right (you don't purchase rights on the market).

Back in 2010, some Democrats described the Affordable Care Act as a starter home for health care reform. Well, I think it is long since time to start talking about building those additions.

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