Zeke Emanuel on the troubled start (but bright future) of the ACA

Over at the Washington Post‘s Wonkblog section, I had a long conversation with Zeke Emanuel about his new book Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System. 

Dr. Ezekiel Emanuel (Photo by Candace diCarlo for University of Pennsylvania)
Dr. Ezekiel Emanuel (Photo by Candace diCarlo for University of Pennsylvania)

We covered the full range of health-wonk topics. Emanuel is scathing about many short-term implementation failures of the Affordable Care. Yet he is quite bullish about health reform’s long-term prospects.

There are a few surprises, too. For starters, Emanuel notes that ACA might have included further malpractice reforms had physician groups or Republican senators really wanted that. Whatever was said in public, behind closed doors doctors didn’t prioritize malpractice; nor were Republicans ready to actually negotiate about it. President Obama and others were ready to deal–were there a deal to be had.

Emanuel also offers some striking blue-sky predictions. Most notably, he predicts that the long trend of explosive health care cost growth will abate. Over the coming decades, he predicts, health expenditures will grow no faster than the national economy: “GDP+0.” If this actually happened, our nation’s public finances would be fundamentally different.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

One thought on “Zeke Emanuel on the troubled start (but bright future) of the ACA”

  1. The conversation doesn't give much indication of why Emanuel thinks that health costs will moderate. Does it depend on the efficacy of public policy? The problem here is that health costs are rising faster than GDP in all OECD countries, with very different policy frameworks and details. The USA can flatten the curve for a fair while – perhaps a decade – by shifting policy and converging with the OECD average, but that does not change the trend in the long run. Or is it a more sophisticated version of my European royalty argument, which does not depend on policy, only on rising income and prevention?

    It maybe worth thinking about the impact of the Hobby Lobby complaint: ridiculous, but it has made it to the the Supremes. From here, it looks like a win-win for the exchanges and a downgrade for employer insurance. Suppose the Supremes support the fundamentalist employer. That weakens employer insurance, as women needing contraceptive coverage (i.e., most) will migrate to the ACA exchanges. Alternatively SCOTUS throws it out, on the sensible basis that employers are not required to offer health insurance at all, so their tender consciences are not coerced by the contraception mandate (see Lederman at Balkinisation on this.) Then fundamentalist employers will drop health insurance benefits, and others may follow, as it saves them money and trouble.

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