The heart of the problem

Julie Appleby puts her finger on it in a Kaiser Health News story,

Better coverage. Health insurance premiums lower than they would have been otherwise. Millions of Americans eligible for rebates in just a little over a year.

Those are some of the benefits the Obama administration continued to tout Tuesday. […]

But even as administration officials embark on a broad expansion of federal oversight of the health insurance industry, they’re up against this reality: Average Americans want premiums to go down, not just go up more slowly. And there’s no single magic bullet – not even the spending rules – that will do that. […]

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, did not quibble with the administration’s historical data on rising premiums. But, he said, premiums mainly reflect underlying health care costs – and he says the law and the administration are doing little to tackle those.

“Medical costs have been rising at unsustainable rates,” said Zirkelbach. “There are a number of things in the law that focus on premiums,” including the 80 percent spending rule, “but now is the time to focus on underlying costs. The reform law really dropped the ball when it came to getting those costs under control.”

So true. And yet I bristle at “dropped the ball.” No ball was dropped. The law passed, barely. Dropping the ball would have been failing to enact the ACA. We got what we could get. It’s not nothing, and it’s not enough.

Health care cost control is very, very hard. It’s technically hard and politically nearly impossible. One can’t just ram cost control “down Americans’ throats” let alone past key interest groups.

The way forward is not to bash the reform we got, but to keep the pressure on Congress, states, and the agencies implementing it. Keep telling them to make the law work. If it does, that’s already more cost control than we would otherwise have. That’s why I shined a spotlight on what’s happened to Medicare Advantage quality bonuses. That’s why I’ll be watching every health care cost-related move the government makes.

We can do better and we must. Americans seem to want premiums to stop growing so fast, but they don’t want to face what that means all at once. Americans certainly want government debt to stop growing so fast. Slowly, slowly, we can deliver better care at lower prices (relative to trend) and solve these problems. There really is no magic bullet. Not one that can get 60 votes in the Senate anyway.

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