Add another achievement to President Barack Obama’s list of remarkable accomplishments. Our President this week became the first sitting President to publish a scholarly article. President Obama penned “United States Health Care Reform: Progress to Date and Next Steps” for the Journal of the American Medical Association. The article includes 68 citations, more actual reliable sources than the Republican nominee for President has made in the last twelve months.
Grouches in the comment section will quibble that the President’s article did not undergo the peer review that marks truly scholarly articles. However, JAMA says this “special communication… went through a two months of fact-checking and multiple edits and revisions.” This paper is no Donald Trump speech.
The President’s article includes six charts:
The President says his plan is saving money:
As a result, health care spending is likely to be far lower than expected. For example, relative to the projections the Congressional Budget Office (CBO) issued just before I took office, CBO now projects Medicare to spend 20%, or about $160 billion, less in 2019 alone.41,42 The implications for families’ budgets of slower growth in premiums have been equally striking. Had premiums increased since 2010 at the same mean rate as the preceding decade, the mean family premium for employer-based coverage would have been almost $2600 higher in 2015.33 Employees receive much of those savings through lower premium costs, and economists generally agree that those employees will receive the remainder as higher wages in the long run.43 Furthermore, while deductibles have increased in recent years, they have increased no faster than in the years preceding 2010.44 Multiple sources also indicate that the overall share of health care costs that enrollees in employer coverage pay out of pocket has been close to flat since 2010 (Figure 545– 48), most likely because the continued increase in deductibles has been canceled out by a decline in co-payments [President Barack Obama, “United States Health Care Reform: Progress to Date and Next Steps,” Journal of the American Medical Association, 2016.07.11].
…and saving lives:
At the same time, the United States has seen important improvements in the quality of care. The rate of hospital-acquired conditions (such as adverse drug events, infections, and pressure ulcers) has declined by 17%, from 145 per 1000 discharges in 2010 to 121 per 1000 discharges in 2014.49 Using prior research on the relationship between hospital-acquired conditions and mortality, the Agency for Healthcare Research and Quality has estimated that this decline in the rate of hospital-acquired conditions has prevented a cumulative 87 000 deaths over 4 years49[Obama, 2016.07.11].
To save more money and more lives, President Obama recommends offering a public option in underserved markets:
…[T]he majority of the country has benefited from competition in the Marketplaces, with 88% of enrollees living in counties with at least 3 issuers in 2016, which helps keep costs in these areas low.57,58 However, the remaining 12% of enrollees live in areas with only 1 or 2 issuers. Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan. Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers.59,60 The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited. Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government 61 [Obama, 2016.07.11].
Brave and realistic Democrats like Rep. Paula Hawks and Jay Williams who are willing to embrace the Obama Administration’s successes may not want to cite all 68 of the President’s footnotes in their stump speeches. But they could use the President’s assessment of Republicans’ harmful hypocrisy and obstructionism over the Affordable Care Act:
Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported. For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in 2003 but opposed them in the ACA. They supported the individual mandate in Massachusetts in 2006 but opposed it in the ACA. They supported the employer mandate in California in 2007 but opposed it in the ACA—and then opposed the administration’s decision to delay it. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. We could have covered more ground more quickly with cooperation rather than obstruction. It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid.65 [Obama, 2016.07.11].
President Obama’s JAMA article makes clear that the Affordable Care Act has done good things for our country. Instead of fantasizing about erasing President Obama’s historic legacy, Congress should focus on building on the ACA’s success.