During most of the time that Obamacare has been around, more people have benefited from its Medicaid expansion than from buying insurance on the marketplaces. But that's no longer true. Final numbers aren't in yet, but Andrew Sprung reports that enrollment in the marketplaces is already up 25% compared to last year and up nearly 80% compared to 2020.
Why? Several reasons, probably, but the main one is the expansion of subsidies passed in 2021 and then extended last year. I haven't posted an update on the number of uninsured people recently, so here's the latest:
After Obamacare passed, the uninsured rate dropped from 16% to around 10-11% and stayed there for several years. Then, in 2021, when the expanded subsidies were passed, the uninsured rate started dropping again. It was at 8.6% in mid-2023, and that was before the big jump of this year. It will be a while before we have updated numbers, but when we do I'll bet that the uninsured rate at the start of 2024 will be down to 8% or so. If the Medicaid holdout states would cut the crap and accept the Medicaid expansion, we'd probably be down to 7%.
That's still 7% too much, but it's a helluva lot better than a decade ago.
But the costs haven’t.
In my experience, few things cost less while getting better. Computers have been the big exception.
Costs will never go down. Socialized medicine would make them go up much more slowly.
There is a good deal of medical care that can potentially be automated. Given that medical care is labor intensive and medical professionals (doctors, nurses, pharmacists, etc.) are very well paid and even the relatively unskilled positions like orderlies tend to be fairly well paid, there's potential for quite a bit of cost reduction if some of that expensive labor can be done by machines.
In the US, there's potential for huge administrative savings. Single payer systems typically have administrative overhead of around 3% of expenditures. In the US, administrative overhead is closer to 30%, and may even be more than that.
Insurance companies are limited to 20% overhead, but the cost of wrestling with insurance companies is born by everyone else in the system, and adds another 10-15% to administrative costs. Get rid of all that bureaucratic nonsense and the total cost of health care should fall by 25-30%.
But the costs haven’t.
US healthcare costs in fact have stabilized as a percentage of GDP for the better part of two decades. Drum has written about this many times. Sure, costs aren't going to actually decline in absolute terms (nor as a percentage of GDP), but that's true of many things, perhaps most. And needless to say, societies tend to want to consume more and better healthcare as they grow more affluent. I know I personally do.
At this point, the US healthcare cost issue isn't "ever upwards growth" so much as "stuck at a lofty percentage of GDP and not getting sufficient value in return."
If the Medicaid holdout states would cut the crap and accept the Medicaid expansion, we'd probably be down to 7%.
Uh, Kev, if Trump is elected, "holdout states" will be the least of our worries. The GOP will make another run at Obamacare as a whole. And this time they'll also be looking for Medicare and Medicaid cuts, probably on a large scale. Sure, there'll be some political blowback, but if, as I suspect, elections become a lot less critical under MAGAuthoritarianism, Republicans will have much freer hand than they did during Trump's first term.