Happy (slightly belated) fifth birthday, Affordable Care Act!
Nearly five years ago now, in The Demi-Decade of Coverage or: The Scalpel and the Chainsaw, I predicted that the ensuing five years or so (say 2011-2015) would be a coverage story, as millions of people gained health insurance. In that respect, mission partially accomplished: 16.4 million and counting so far. But while the ACA had many components that had potential to ultimately tame rising health care costs, that wasn't something we could anticipate to start seeing in the first demi-decade. Maybe not even in the second demi-decade: "All of this means that we can't really expect real cost curve bending to happen until the second decade of the law's existence (the 2020s)."
Wrong!
Aided in no small part by the Great Recession, health care spending growth fell. But even as the
economy recovered, it stayed historically low. The last five years have been unprecedented. More and more observers, even those reluctant to look for culprits beyond the sluggish economy, are now recognizing that structural changes in the health care sector--real, lasting transformation of the way that industry does business--may well be taking root.
This first five years of the ACA era has indeed become not just the Demi-Decade of Coverage but also, surprisingly, the first Demi-Decade of Cost Control.
And now we find ourselves at a crossroads.
We're (largely) solving our health insurance coverage problem, but how do we simultaneously tackle our cost growth and quality improvement conundrums?
I'm about to lay out my thoughts on that in some depth through this series (these will become links as I get around to posting them):
I. Squeezing Blood from a Stone
II. Universe A: The Health Care Polis
III. Universe B: The Health Care Market
Interlude: The Biggest Question
IV: Untitled Synthesis
Let's begin!
Nearly five years ago now, in The Demi-Decade of Coverage or: The Scalpel and the Chainsaw, I predicted that the ensuing five years or so (say 2011-2015) would be a coverage story, as millions of people gained health insurance. In that respect, mission partially accomplished: 16.4 million and counting so far. But while the ACA had many components that had potential to ultimately tame rising health care costs, that wasn't something we could anticipate to start seeing in the first demi-decade. Maybe not even in the second demi-decade: "All of this means that we can't really expect real cost curve bending to happen until the second decade of the law's existence (the 2020s)."
Wrong!
Aided in no small part by the Great Recession, health care spending growth fell. But even as the
This first five years of the ACA era has indeed become not just the Demi-Decade of Coverage but also, surprisingly, the first Demi-Decade of Cost Control.
And now we find ourselves at a crossroads.
We're (largely) solving our health insurance coverage problem, but how do we simultaneously tackle our cost growth and quality improvement conundrums?
I'm about to lay out my thoughts on that in some depth through this series (these will become links as I get around to posting them):
I. Squeezing Blood from a Stone
II. Universe A: The Health Care Polis
III. Universe B: The Health Care Market
Interlude: The Biggest Question
IV: Untitled Synthesis
Let's begin!
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