What to Read on Implementation of the Affordable Care Act

More Solid Proof That Obamacare Is Working — Rick Ungar

The provision of the law that permits young adults under 26…to remain on their parents’ health insurance program resulted in at least 600,000 newly insured Americans during the first quarter of 2011.

…every one of the young immortals we add to the rolls of the insured is one less young adult who will turn to the emergency room to fix a broken leg and then find themselves unable to pay the bill — leaving it to the rest of us to pay the tab.
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Because the under 26 crowd tends not to get sick, adding them to the insurance pools helps bring the very balance that was intended by the new law. The more healthy people available to pay for those in the pool who are ill (translation: the older people), the better the system works and the lower our premium charges should go.

[And] there has been a significant uptick in small businesses taking advantage of the tax benefits offered by the ACA to provide health insurance to employees where they previously did not do so.

Do Pay-for-Performance Health Programs Really Work? — Jake Marcus

Earlier this month, Medicare finalized the rules of a new program — mandated by the Affordable Care Act — that will pay hospitals based on the quality, not just the quantity, of care they provide.

In general, there are two ways to reward healthcare providers: 1) based on the health outcomes of patients or 2) based on how closely hospitals adhere to recommended processes of care.

Medicare has started relatively small by choosing to redistribute only 1 percent of reimbursements, so it will have the chance to evaluate the effects of a promising program without it having disastrous consequences if it fails.

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Less Is More: The Ugly Truth about American Health Care

I have been promising this post for a month. I’m sorry for the delay. I hope it was worth the wait.

A Health Care Crisis, More or Less

Last month, Atul Gawande—surgeon, professor, and journalist—published an essay in The New Yorker on the disparity and inefficiency of American health care spending, highlighting in particular the poor performance of McAllen, Texas. Gawande’s article rocked the policy world. The real news, though, is not the sad facts that Gawande brought to light, but rather the fact that it is considered news at all, for health economists have spent many years trying to wake up the media and the public to this state of affairs.

Gawande took a commonly accepted premise, “Americans like to believe that, with most things, more is better.” And then he shattered our happy little world, “But research suggests that where medicine is concerned it may actually be worse.”

Okay, it’s not that shocking. More has been the watchword of the last thirty years in more than just health care, and most of us recognize we haven’t exactly been well served by it. More, roughly speaking, is responsible for a housing bubble, a financial crisis, an unsustainably warming climate, and now a health care system that is making us sicker and poorer than most other industrialized nations.

But more isn’t all bad. Any economist will tell you that more is responsible for the unprecedented economic growth of the last century—and hence, the way of life we hold so dear. In fact, it is exactly the opposite of more that we fear the most. Open any newspaper these days, and you’re bound to find the word “rationing” at least once. Maybe we can accept that more is not always better, but in exchange, are we willing to accept…less?

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