Just a quick follow up to Aaron’s post. He and I both get lots of comments and e-mail to the effect of, “Why do you support this costly new health reform law? Aren’t you interested in lower health costs?”
Actually, there are a number of ways to answer this question. Most superficially though, it’s pretty simple. Good things cost money. I think reforms to the insurance market (banning pre-existing condition exclusions, setting up exchanges, even the mandate, etc.) included in the ACA are good things. I’m happy to spend some of my taxes on those. (I’m not speaking for Aaron but I’d be he’d agree with me on this and what follows.)
But I don’t want my taxes wasted. I do want them to be spent efficiently. So, yes, I’m interested in lower health costs. Just not at the expense of worse access to insurance and the care it facilitates. This is not an inconsistent position.
Thus, the ACA has some good elements in it and some things that could and should be improved. It’s got some problems, including the fact that it doesn’t sufficiently address the trend in health care costs. But that’s not so much a problem with the ACA as a problem with the system it fails to fully reform. So, we must continue to work on those problems. Nearly every day on this blog Aaron is or I am (or we both are) posting research-based ideas to improve our understanding of the problems and suggesting potential solutions or limitations to solutions, and so forth. So, we’re trying to be productive.
There’s a lot more to this question, “Aren’t you interested in lower health costs?” What is meant by “lower”? What should be our target? How far from it are we? And, much more deeply, how much control over spending should we, or our government, exert? How much control do we really have in a largely free society with a largely market-based economy (with still a largely market-based health care system) that is shaped by laws and regulation, themselves constructed by a political process over which we and special interests have a lot of influence? What kind of control do we think we have or can have? It’s a deep question, really.
Aaron and I will get to all those questions in the next few weeks, or that’s the plan anyway.