Learning to love Obamacare, cont.

Recently, conservative healthcare policy commentator Avik Roy pivoted from a long history of denouncing the Affordable Care Act to acceptance of its status as law of the land and thence to a happy vision of a marriage between Obamacare and Ryancare, whereby seniors are progressively migrated onto the ACA's exchanges, and Medicare's remaining "public option" (traditional Medicare) becomes available to non-seniors on the ACA exchanges.

This pivot highlights the Heritage Foundation pedigree of the ACA: Democrats embraced "premium support" and healthcare exchanges because the combo seemed the only form of universal healthcare provision that Republicans could support; Republicans promptly demonized the effort even as they proposed migrating its structure into Medicare. In any case, the ACA exchanges should indeed serve as a proving ground for the dubious notion that managed competition among insurers will reduce healthcare costs.

A recent article by two partners at Mercer Health and Benefits, a major HR consultant, highlights another effect of the ACA that should cheer conservatives.  The ACA's coverage mandates, Tracy Watts and Eric Grossman assert, have raised the cost of coverage and so led more employers toward a form of health insurance that shifts more costs to policyholders and possibly lowers them overall:

The only adult in the (Heritage Foundation) room

Perhaps Donald Verrilli did not have the smoothest delivery in the Court on March 27, when he defended the constitutionality of the individual mandate.  But in this Heritage Foundation panel discussion, as reported by Josh Gerstein, he seems on a different moral plane entirely from plaintiff's attorney Michael Carvin and libertarian U. of Chicago Professor Richard Epstein:

Public plan advocates, read this...

According to the Heritage Foundation's Robert A. Book, it's a myth that Medicare controls costs better than private insurers. The slower growth in Medicare spending is due mainly Medicare shifting more costs onto patients and their other insurance sources:

Medicare's share of total spending on health care services for non-institutionalized Medicare enrollees fell from 72.2 percent in 1997 to 50.8 percent in 2005.[27] The remaining 49.2 percent was covered by a combination of private insurance, including employer-sponsored insurance (for employees and retirees) and individually purchased Medigap plans (21.4 percent); beneficiaries' out-of-pocket spending (15.7 percent); and other public plans, including TRICARE, Veterans Health Administration, and Medicaid (12.0 percent). Total spending per capita in 2005 was $12,157, including $6,180 paid by Medicare and $2,603 paid by private insurance.[28]

Over time, Medicare's share of health care spending for Medicare beneficiaries has fallen, while private insurance's share has risen. In 1997, Medicare's share was 72.2 percent, and the private-insurance share was 12.2 percent. Total spending per capita in 1997 was $5,438, including $3,925 from Medicare and $662 from private insurance.[29]

While total per-capita health care spending for Medicare enrollees increased by 124 percent from 1997 to 2005 (an average of 10.6 percent per year), spending by the Medicare program increased by only 57.5 percent (5.8 percent per year). Meanwhile, private insurance spending on Medicare beneficiaries increased by 294 percent (18.7 percent per year), and out-of-pocket spending by Medicare beneficiaries increased by 205 percent (15.0 percent per year).

Book also claims that Medicare does not have lower administrative costs than private plans, that it does not use superior bargaining power to reduce costs, and that it is not more innovative than the private sector.

Book takes on Jacob Hacker and Paul Krugman, amongst others. I'd be interested to see a detailed rebuttal.