1. Once Obamacare goes into effect, it will be impossible to substantially cut it back. Both sides seem convinced of this — Republicans in terror, Democrats in glee. Funny thing, though — the other day, my father mentioned casually that many of his classmates at the Syracuse’s Maxwell School of Public Policy in the mid-to-late 1960s had been on Medicaid. And then, suddenly, they weren’t.
It turns out that in 1965, when Medicaid passed, the State of New York had a great idea: shower a bounty of federal money on New Yorkers by setting the income eligibility limits much higher than other states. They financed this by requiring the local government to kick in 25 percent of the cost. The Feds matched state + local dollars, so that for each dollar New York State spent, it got one local and two federal dollars to go along with it. At the income levels they set, a third of the state was eligible….
2. Accountable Care Organizations are certain to bring down overall health spending . Here’s another interesting observation I heard the other day, this time from a participant in the recent Brookings’ papers: it’s not clear that ACOs are going to save money. The idea behind ACOs is that they will help us move away from fee-for-service medicine, in which doctors are paid for doing stuff, and toward a system where doctors are paid by the patient, a system usually rendered in the popular lexicon as “paying for health, not treatment.” The unspoken underlying assumption being that this means “paying less for health.”