I’m getting tired of ”studies” (mostly: subtle or not-so-subtle position papers) talking about whether the Patient Protection and Affordable Care Act (PPACA) exchanges are wild successes or miserable failures based on:
- One shaky indicator.
- One small set of shaky indicators.
- In the case of PPACA supporters: joyous predictions of utopia based on numbers that an analyst at the Congressional Budget Office, a fellow at the Urban Institute, or a cat’s Ouija board cooked up.
Example: The U.S. Department of Health and Human Services (HHS) was supposed to get the exchange applications from would-be exchange plan sellers by this past Friday.
HHS has not posted any application quantity numbers, which might be a genuinely bad sign.
Some people who really dislike the exchanges have pointed out that some state exchanges might not attract all that many carriers.
But, let’s face it: A lot of states don’t have much effective competition in the health insurance market today. Some states might have 20 carriers today on paper and one or two that matter.
The Obama administration and its friends played the prediction game by coming up with estimates of how many people in each state will qualify for the PPACA health insurance premium tax credit in 2014.
Well, sure. Great. But let’s see what people really end up paying for coverage.
Then there are the people who say the PPACA sky is falling because rates for young guys in states that now have rate regulations that the health insurers themselves secretly probably think are kind of weak will go up.
Well, no kidding. Young, healthy, high-income guys might have to pay more coverage so that they’ll still have some access to coverage when they’re old and sick?
Who woulda thunk. My suspicion is that even a lot of Republican and health insurance industry alternatives to PPACA have increases for young, healthy, high-income guys tucked in there in way or another.
On the one hand, young, healthy guys have strokes, heart attacks and injuries and become uninsurable, too. Just structuring free-market policies in such a way that young, healthy guys who become uninsurable will still have real access to coverage (or access to quick, comfortable, end-of-life acceleration services; take your pick) probably will add to costs for those young, healthy guys.
The best indicators for how the health market is doing have to involve cost and access for everyone, including the people who are now in the government plan market and who are uninsured.
On the other hand, no one really seems to be interested in seeing what works. Each side just seems to want to pound on the table with a sledgehammer.
On the third hand, our health care system has problems now, and clearly, according to everyone who’s paying much attention, will still have problems in 2014, no matter whether PPACA works or fails. It would be good if we had more visible people out there using measuring tapes, thermometers and chisels and fewer with sledgehammers.