Ruth Marcus BELIEVES in the new health care reform law. But she points out that no one knows exactly what it will do:
If I were a member of Congress, my floor speech before casting a yes vote would have boiled down to:
Gee, I hope this works.
One of the astonishing aspects of the health-care debate is how little is actually known about the implications of a change this far-reaching. Everyone has a theory, and a model to match, but even some of the most fundamental questions remain the subject of debate.
On the most basic of all — does having health insurance lead to better health? — the evidence is solid but not unanimous. The Institute of Medicine, reviewing the literature in 2009, found that “the body of evidence on the health consequences of health insurance is stronger than ever before. . . . Simply stated: Health insurance coverage matters.”
But a study that same year by Richard Kronick, a former health-care adviser to President Bill Clinton, found “little evidence to suggest that extending insurance coverage to all adults would have a large effect on the number of deaths in the United States.” . . .
To take another example, one common assertion has been that the uninsured end up getting health care — just more expensive health care, in emergency rooms and when conditions have worsened, with the costs passed on to the rest of the population. The notion that the tab is being picked up one way or another makes intuitive sense.
A new National Bureau of Economic Research paper by Michael Anderson, Carlos Dobkin and Tal Gross questions this assumption. The researchers examined health-care consumption by 19-year-olds who had just been dropped from their parents’ coverage. They found that not having insurance resulted in a 40 percent reduction in emergency room visits — “contradicting the conventional wisdom that the uninsured are more likely to visit” the emergency room and a 61 percent drop in hospital admissions.
“Overall, these results suggest that an expansion in health insurance coverage would substantially increase the amount of care that currently uninsured individuals receive and require an increase in net expenditures,” the authors write. Emergency room visits could increase by 13 million annually, and hospital admissions by 3.8 million, they project. . . .
Will younger adults, who account for about half the population of uninsured non-elderly adults, sign up for coverage — or will they pay the fine instead? How will that decision affect premium levels and the adequacy of federal subsidies?
Will the expansion of coverage create a shortage of health-care providers and result in higher prices, or will, for example, higher Medicaid payments for primary-care doctors stem an exodus of doctors from the program? Will employers add coverage because workers facing the mandate to obtain insurance will press for it, or will they drop it because it will be cheaper to pay the penalty and let employees fend for themselves?
Will increased coverage of preventive care save money because diseases will be caught earlier — or will the added cost of widespread screening exceed the economic benefits? The Congressional Budget Office has concluded that, “for most preventive services, expanded utilization leads to higher, not lower, medical spending overall.”
We don’t even know the regular consequences of this new health care system. Let alone the unintended consequences.