I discussed the slowing of health care delivery inflation here. The New York Times published an op-ed by Zeke Emanuel and Jeffery Leibman that further illustrates how maintaining the  Affordable Care Act is necessary to continue bending the cost curve. Using several examples of expensive, marginally effective therapy, they point out that much of the cost of Medicare is based on income maximization on the part of care providers as they function in this fee-for-service world. Their critique of the anti-ACA alternatives as a method of cost control are as follows:

  • Meat-cleaver cuts hack spending indiscriminately. Cuts that fail to distinguish between high-value and low-value medical care would do more harm than good.
  • Cost-shifting cuts don’t actually reduce health care spending; they just shift costs from the government to the private sector. … raising the eligibility age [for Medicare] would reduce government spending on Medicare, it would shift the costs to individuals and businesses. It would also increase the number of uninsured 65- and 66-year-olds, leading to worse health outcomes and making it harder for older Americans to find work.
  • Penny-wise, pound-foolish cuts reduce current spending by a little but raise future costs by a lot. Raising co-payments for office visits and medications is a good example. Research shows that when older adults are charged higher co-payments, they reduce their primary care visits and use of prescription drugs. But the research also shows that forgoing this outpatient care leads to an increase in expensive hospitalizations.

They point out that already in place in the ACA are provisions that incentivize improved care delivery at reduced cost. They close with the following

The seeds of a solution lie in the accountable care organizations, medical homes and bundled payment reforms that were authorized by last year’s Affordable Care Act. Accountable care organizations are groups of health care providers and hospitals that work together to treat patients. Medical homes coordinate primary care services. And bundled payments consolidate the many costs of an episode of care, like a hospitalization, into a single payment, incentivizing efficient delivery of tests and treatments. All of these reforms allow payments to be based primarily on the number of patients cared for and the quality of that care rather than on the volume of services provided.

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