• Why is this so hard to understand? (Part 3)

    This is a corollary to my last post. If you think that provider payments can’t be decreased, or maybe even need to be increased, then someone has to pay for it. Period.

    There’s no magic here. If you don’t like IPAB because it  might recommend that we pay physicians less, or you don’t like ACOs because they will restrict practice, or if you’re just against reducing payments for any other reason, that’s fine. But remember that increasing payments means increasing spending.

    That has to be paid for! So you can either increase the amount that government has to pay (bad for the deficit) or you can increase the amount that seniors have to pay (bad for seniors). There’s no alternative.

    You can hate the ACA, but it doesn’t want the government to pay, nor does it want seniors to pay, so it’s taking steps to reduce the amount that will be spent on medicare.

    Those who dislike the ACA are demonizing the mechanisms by which the ACA reduces spending. But if removing those measures means that Medicare spending has to go up, meaning that government spending has to go up, or seniors have to pay more. Both of those are non-starters in a campaign.

    So instead, they claim that spending will go down by other means. Of course, if that succeeds, then we will likely spend less on health care, and providers will make less (see Part 2). If it doesn’t, someone has to pay.

    Part 1 is here. (When Medicare spending goes up, seniors’ premium costs go up.)

    Part 2 is here. (You can be for reducing Medicare spending, or you can be for increasing Medicare spending, but you can’t be for both.)

    @aaronecarroll

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