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Affordable Care Act

David Brooks Hasn't Heard of the Affordable Care Act

David Brooks has apparently not heard of the Affordable Care Act (ACA) since he thinks he is providing new information in telling readers that markets can work in health care. If he was familiar with the law, then he would realize that the ACA was quite explicitly designed with the idea that patients should share in costs, and therefore have incentives to seek lower cost care.

As a practical matter, this has not worked out very well, since patients tend not to do comparative shopping for health care services. This means that giving them more control does little to hold down health care costs. A recent study by the Rand Corporation found that patients with high deductible plans did spend less on health care but also tended to avoid recommended preventive procedures such as cancer screenings. Since this was a relatively short-term study, it did not include the higher long-term costs that may result from patients not receiving preventive care.

It is worth noting that Brooks seems uninterested in ways in which obstacles to a well-working market may raise costs but also raise the income of highly paid people. For example, in most markets there is very little competition between insurers. This means that patients have few options if their insurers give them a bad time paying bills — in effect stealing patients' money. (Personal note: I had to spend two hours on the phone, in three separate calls, to get my insurer [United Health Care] to pay a bill that was for a procedure that was completely standard, prescribed by my doctor, and obtained at an in-network provider. The value of the time I wasted, and that other patients must waste, are not generally included in calculations of health care costs.)

CEPR / January 14, 2017