Affordable Care Act

One interesting thang about the ACA is that health care inflation slowed significantly in the decade after its implementation compared to the prior decade, both in absolute terms and relative to overall inflation.

Moreover, the rate at which healthcare spending as a percentage of GDP was growing also slowed significantly. In spite of demographics (an aging population) and increasing rates of obesity.
For a program that is an unquestioned failure those are impressive results.

And incidentally, the number of uninsured Americans dropped sharply.
 
There are lots of public goods that require unfathomable subsidies. Such as national defense. Education. Highways. The alleviation of poverty. It is up to us as a society to decide these thangs. Obamacare curbed healthcare inflation. It curbed the rate at which healthcare spending was increasing as a percentage of GDP. In spite of things like an aging population, the obesity epidemic and the opioid epidemic. And it greatly reduced the number of people without health insurance. There is an impressive body of research showing how states who have declined to participate have suffered very poor outcomes relative to those who have.
 
what is the evidence on outcomes in states that accepted obamacare subsidies versus those that didn't

ChatGPT said:​


Thought for 13s

Short answer: states that adopted the ACA’s Medicaid expansion (and other key ACA features) show consistently better population-level outcomes than states that did not — notably much larger drops in uninsured rates, better access and use of care, improved financial protection (less medical debt and uncompensated care), stronger hospital finances (especially for safety-net and rural hospitals), and accumulating evidence of reduced mortality — although effect sizes vary by study, population, and time period. Below is a concise, evidence-backed summary with the most important citations.

Quick evidence summary​

  • Big increases in coverage / big drops in uninsured rates. Expansion states saw large reductions in uninsured rates for low-income adults (often 10–20 percentage points for the target populations) versus much smaller changes in non-expansion states. KFF+1
  • Improved access and utilization. Expansion is tied to increased primary care visits, prescription fills, preventive services, and fewer unmet care needs due to cost. The literature finds consistent coverage → access effects in expansion states. KFF+1
  • Financial protection for households. Studies show expansion reduced unpaid medical bills, collections, and medical-debt filings among affected low-income adults. PMC
  • Lower uncompensated care / better hospital finances (especially safety-net & rural hospitals). Hospitals in expansion states saw sharp drops in uncompensated care and improved margins; non-expansion states experienced higher uncompensated care burdens and many rural hospital closures disproportionately occurred in non-expansion states. Commonwealth Fund+2GQ+2
  • Emerging and growing evidence of mortality reductions. Multiple quasi-experimental studies and recent working papers find that Medicaid expansion is associated with reduced all-cause mortality among low-income adults (estimates vary: a few percent reduction in mortality for the low-income adult population in some papers; other broader estimates translate to relative reductions on the order of ~2–6% depending on study and population). These results are stronger when studies have broad geographic scope and longer follow-up, but effects vary by state and subgroup.
 
https://www.wsj.com/opinion/deregulation-can-make-medications-cheaper-8ce81633

When politicians such as President Trump and Sen. Bernie Sanders want to lower pharmaceutical prices, they resort to heavy-handed approaches through mandates. While that approach is direct and at least superficially logical, it’s not optimal. Instead of trying to force drug prices lower, we should make drug development cheaper.

Drugs are expensive to develop. If the government mandates lower prices, drug companies are squeezed and respond by developing fewer drugs—reducing innovation and the therapeutic choices desired by patients and doctors. Lowering the cost of drug development would foster more innovation, more therapeutic alternatives, more competition and lower prices for new drugs, which wouldn’t need to return outsize profits to pay for high development costs. It would be a win for everyone.

There’s an easy solution that won’t compromise safety—a solution that was once the law of the land and has strong evidence to suggest it worked better than the system we have today. From 1938 through 1962, the Food and Drug Administration required proof of safety before drug approval but not proof of efficacy. The approach was abandoned due to a significant misunderstanding of the thalidomide tragedy—when thousands of babies outside the U.S. were born with severe birth defects.

The issue with thalidomide was a failure of safety, not efficacy. But under pressure to react, Congress required, through the Kefauver-Harris Amendments of 1962, proof of efficacy before granting marketing approval. The new rule addressed a problem that didn’t exist and, in doing so, imposed a substantial new cost burden.

Before 1962, developing a drug took about two years. Now it takes 12 to 14 years. Since 1975 real development costs have risen about 7.5% a year, roughly doubling every decade. Today, we estimate that bringing one successful drug to market costs about $9 billion on average. (This includes the cost of failed drugs and the time value of money.)

—————

Government failure, not market failure.
 
acesfull86 said:
https://www.wsj.com/opinion/deregulation-can-make-medications-cheaper-8ce81633

When politicians such as President Trump and Sen. Bernie Sanders want to lower pharmaceutical prices, they resort to heavy-handed approaches through mandates. While that approach is direct and at least superficially logical, it’s not optimal. Instead of trying to force drug prices lower, we should make drug development cheaper.

Drugs are expensive to develop. If the government mandates lower prices, drug companies are squeezed and respond by developing fewer drugs—reducing innovation and the therapeutic choices desired by patients and doctors. Lowering the cost of drug development would foster more innovation, more therapeutic alternatives, more competition and lower prices for new drugs, which wouldn’t need to return outsize profits to pay for high development costs. It would be a win for everyone.

There’s an easy solution that won’t compromise safety—a solution that was once the law of the land and has strong evidence to suggest it worked better than the system we have today. From 1938 through 1962, the Food and Drug Administration required proof of safety before drug approval but not proof of efficacy. The approach was abandoned due to a significant misunderstanding of the thalidomide tragedy—when thousands of babies outside the U.S. were born with severe birth defects.

The issue with thalidomide was a failure of safety, not efficacy. But under pressure to react, Congress required, through the Kefauver-Harris Amendments of 1962, proof of efficacy before granting marketing approval. The new rule addressed a problem that didn’t exist and, in doing so, imposed a substantial new cost burden.

Before 1962, developing a drug took about two years. Now it takes 12 to 14 years. Since 1975 real development costs have risen about 7.5% a year, roughly doubling every decade. Today, we estimate that bringing one successful drug to market costs about $9 billion on average. (This includes the cost of failed drugs and the time value of money.)

—————

Government failure, not market failure.
Click to expand...
Yes. That would be an example of a poor policy response to tragedy. There are enough actual for real examples of government failure or bad policy that we don't have to reach for imaginary ones.

And of course there are plenty of examples of good policy as well. Those need acknowledgment, even if they cause some ideological discomfort.
 
You must log in or register to reply here.
Back
Top