Tuesday, February 2, 2016

The ACA and Economic Growth

Has the ACA helped or hurt. If you listen to The Commonwealth Fund you would think it is the greatest thing since sliced bread. Well, perhaps the Whopper. Or the Big Gulp.

They state:
  • The U.S. economy has gained nearly 14 million private sector jobs over five years. All of the net gain in employment has been in full-time work.
  • There are 5 million more people working now than during the peak level prior to the recession, and the unemployment rate has plummeted. Recent annual gains in jobs have been faster than gains in any year since the 1990s.
  • Still, labor force participation rates have yet to return to their pre-recession peak.
  • Inflation-adjusted economic growth in the United States in recent years has rivaled or exceeded that of many other high-income nations.
  • Health care spending growth per person—both public and private—has slowed for five years. 
  • A number of ACA reforms, particularly related to Medicare, have likely contributed to the slowdown in health care spending growth by tightening provider payment rates and introducing incentives to reduce excess costs. 
  • Faster-than-expected economic growth and slower-than-expected health care spending have led to multiple downward revisions of the federal deficit and projected deficits.
  • These trends have also been a boon to state and local government budgets, as job growth has improved state tax revenues while cost growth in health care programs has slowed. At the same time, expanding insurance to millions of people who were previously uninsured has supported local health systems and enhanced families’ ability to pay for necessities, including health care.
 Well not so fast Swiftly.

The jobs gained fail to account for the dramatically lower Participation Rate, a factor we have been focusing on since the early days of the Romer Curve. You see Romer presented her now infamous curve seven years ago in January 2009 saying that unemployment would be at 5%. But 5% of what. If you take tens of millions out of the workforce than you eventually get to 5% but if you were to normalize to prior Participation Rates you would be back at 9%!

Economic growth is horrible. Do these folks ever look at the GDP growth rates, in fractional digits! That is less than 1% pa.

Now to Health Care. The biggest burden on Health Care is the EHR created by the now head of this entity. It is the worst creation ever. It should have been cloud based and patient centered. Instead it is physician based and incompatible. One physician cannot get the records of another unless they go through the patient! Duh! Told you so folks.

You see we have the ability to do a good EHR. Simple:

1. Patient based. Single cloud based HIPAA compliant where for each patient the practitioner can ask and add. It is portable.

2. Digitally readable info is uploaded, parsed, collated, and portable. That is a biopsy may be added and the results parsed and added to a hypertext readable and accessible system.

3. Image enhances and readable. All images are stored and indexed and accessible. Want an MRI, here it is.

4. Accessible via simple interfaces.

5. Cheap. Yes, one system and no complex learning. Let the system do the learning.

Well did this happen.No. Thank the folks at Commonwealth!

Oh about those job growth comments. We have just added more to manage a health care practice with negative value. Thanks guys!