Yesterday's yearly reports from the trustees of Social Security and Medicare yielded new information about how the Democrats' Affordable Care Act will affect the cost of health care. The report [PDF] concludes the bill "improves the financial outlook for Medicare substantially" to the point where Medicare, which provides health insurance to the elderly, will see its trust fund extended 12 additional years. Paul Krugman has the relevant graph comparing last year's projections to this year's:
Brad Delong calls this "the biggest move toward long-run fiscal responsibility ever." This is true, but let's face the facts and consider the hard work ahead. A much more interesting -- and troubling -- graph comes from an appendix prepared by the trustees that presents an "Alternative Scenario" [PDF] that takes into account what happens if we don't implement the health-care overhaul effectively:
As you can see, there's a big gap between fully implementing the bill and letting cost-cutting measures slide, although even the worst implementation is clearly some improvement over the status quo. The report's authors explain:
The projections shown in the 2010 Trustees Report for current law should not be interpreted as our best expectation of actual Medicare financial operations in the future but rather as illustrations of the very favorable impact of permanently slower growth in health care costs, if such slower growth can be achieved ... While the significant improvements in Medicare‟s financial outlook under the Affordable Care Act are welcome and encouraging, expectations must be tempered by awareness of the difficult challenges that lie ahead in improving the quality of care and making health care far more cost efficient.
That means supporters of health-care reform can't afford to rest on their laurels as health care gets implemented. No doubt opponents of the Affordable Care Act will use this information to cast aspersions on the bill itself, but the reality is that fixing our health-care system is a multi-year process, and this legislation created a necessary framework but can't do everything in one fell swoop. Congress has shown a general willingness to sustain Medicare cuts, even if the Doc fix clearly needs attention. If you're interested in reading more, it just so happens that the Prospect has just published a timely special report on the challenges in implementing the health-care bill.
-- Tim Fernholz
