[The Soup Nazi]

(2/2)

Part of the answer is that before Obamacare went into effect, the uninsured in America consisted disproportionately of relatively young adults — and the health costs of younger people are, on average, much lower than those of seniors (who were already covered by Medicare). So covering many of the uninsured was never going to cost all that much, unless the policy design was fatally flawed, which it wasn’t.

Beyond that, the enactment of the A.C.A. coincided with a sustained slowdown in the growth of overall health care spending:

 

We don’t know exactly why this happened. The A.C.A. contained a number of measures intended to control costs, which may partly explain the bending of the curve. It’s worth noting, however, that health costs have leveled off across the advanced world. It’s possible that the direction of technological progress in medicine has shifted, generating fewer ways to treat the previously untreatable and more ways to deliver care more cheaply. And to some extent we may be seeing the effects of Stein’s Law: If something cannot go on forever, it will stop. Health spending couldn’t absorb an ever-growing share of national income, so at a certain point insurers and providers began to take cost control seriously.

In any case, Obamacare has worked. It didn’t provide universal coverage, but it did provide health insurance to millions of Americans, some of whom desperately needed that safety net — and it did so without breaking the bank. Predictions that the A.C.A. would be unworkable have been proved wrong. At this point, the only serious threat the program faces — and it is a serious threat — is political: People who kept insisting, wrongly, that health reform would die of its own accord may simply step in to kill it.

Quick Hits

45 million people.

Republicans still really hate Obamacare.

Some states (including Massachusetts and New York) have close to universal health care.

Arguably it should be called Pelosicare.