There is a bias in medicine against talking to people and for cutting, scanning and chopping into them. If this was a pill or or a machine with these results it would be front-page news in the Wall Street Journal. If we could get these results for your grandmother, you’d say, ‘Of course I want that.’ But then you’d say, what are the risks? Does she need to have chemotherapy? Does she need to be put in a scanner? Is it a surgery? And you’d say, no, you just have to have a nurse come visit her every week.

The health reform law boosted Medicare fees for primary care ambulatory visits by 10 percent for five years starting in 2011. Using a simulation model with real-world parameters, we evaluate the effects of a permanent 10 percent increase in these fees. Our analysis shows the fee increase would increase primary care visits by 8.8 percent, and raise the overall cost of primary care visits by 17 percent. However, these increases would yield more than a sixfold annual return in lower Medicare costs for other services—mostly inpatient and postacute care—once the full effects on treatment patterns are realized. The net result would be a drop in Medicare costs of nearly 2 percent. These findings suggest that, under reasonable assumptions, promoting primary care can help bend the Medicare cost curve.

Can slower Medicare growth be sustained?

On the whole, we do not believe that the recent slowdown in Medicare spending growth is a fluke. There has been a long-term trend toward tighter Medicare payment policy, and policy changes that began in the middle of the 2000s have continued that tightening. The Deficit Reduction Act of 2005 (DRA) reduced payment rates for imaging, home health services, and durable medical equipment, and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made substantial cuts to Medicare Advantage plans. Even though Congress has overridden payment cuts dictated by the sustainable growth rate formula (SGR) each year, the resulting physician-fee increases have fallen further and further below the relevant index of inflation. All these specific constraints on payment rates probably also slowed growth trends in the volume of services provided, leading to a larger slowdown in spending growth.

Moreover, the DRA and MIPPA were only pale previews of the payment-rate cuts in the Affordable Care Act (ACA). The ACA permanently slows the growth in Medicare payment rates for almost every category of provider other than physicians and makes additional targeted cuts to home health agencies and some other providers. As a result, the CBO projects that over the next decade Medicare spending per enrollee will grow substantially more slowly than the overall economy, even if there is a permanent SGR “fix.” Negative excess growth in Medicare is not as implausible as it might first sound — such a trend occurred in the late 1990s and early 2000s in the wake of the Balanced Budget Act of 1997.

The birth control fight is really about health care

Almost all of the members of Congress who don’t think birth control should count as a covered basic service, don’t actually think anything should qualify—at least as regards the health care needs of people born after the year 1957. It’s interesting that this profound disagreement about the provision of health care services to people born in 1958 or 1985 exists alongside an absolute consensus that people born in 1957 or earlier should enjoy a single-payer health care system. But the fact is that, as regards people born in the past 54 years, an enormous philosophical chasm has opened up about the whole idea of health care provision. The birth control aspect of this has gotten a lot of press because a lot of people find it more accessible than the larger health care picture, but it’s worth seeing the fight in context.

The United States stands out as performing very well in the area of cancer care, achieving higher rates of screening and survival from different types of cancer than most other developed countries. The United States does not do well in preventing costly hospital admissions for chronic conditions, such as asthma or complications from diabetes, which should normally be managed through proper primary care.

The cost of not controlling health-care costs

RAND Health researchers combined data from multiple sources to depict the effects of rising health care costs on a median-income married couple with two children covered by employer-sponsored insurance. The analysis compared the family’s health care cost burden in 1999 with that incurred in 2009. The take-away message: Although family income grew throughout the decade, the financial benefits that the family might have realized were largely consumed by health care cost growth, leaving them with only $95 more per month than in 1999. Had health care costs tracked the rise in the Consumer Price Index, rather than outpacing it, an average American family would have had an additional $450 per month — more than $5,000 per year — to spend on other priorities.

Things Mitt Romney won’t tell you: Romneycare is working

In 2010, John F. Cogan, R. Glenn Hubbard, and Daniel P. Kessler published in Forum for Health Economics & Policy a report (“The Effect of Massachusetts’ Health Reform on Employer-Sponsored Insurance Premiums”) on the effects of Governor Mitt Romney’s 2006 health-care reform in Massachusetts. This report suggested that, up until 2008, these reforms (hereafter referred to as “Romneycare”) led to a relative increase in health-insurance premiums. This report was cited numerous times by opponents of Romney and helped fuel the belief that Romneycare caused health-insurance premiums to skyrocket in Massachusetts (even though Cogan et al. did not make this claim).

However, new data has now come out (covering through 2010), and this data tells a rather different story. It instead suggests that Massachusetts’s health-insurance premium growth declined relative to the nation as a whole in the years since Romneycare has been enacted. From 2006 to 2010, employer-sponsored health-care premiums for a family rose about 19% in Massachusetts, while they rose about 22% in the US as a whole. Compare that to the period between 2002 and 2006, when Bay State family premiums increased 40% and US family premiums rose only 34.5%. Family premiums have seen the greatest reduction in growth since Romneycare; individual premiums have also slowed their rate of growth, though by not as much. For both family and individual premiums, the rate of growth fell below the national average in the period between 2008 and 2010.