Another Detour to Our Supposed Primary Health Care Focus

Not sure when the last time is that the federal government issued a sensible health care policy, one likely to actually reduce costs or improve quality.  A recent report from the Congressional Budget Office examines a number of projects from the Center for Medicare and Medicaid Innovation, which was created by Obama’s woefully misnamed Affordable Care Act.  The CBO had originally projected that the Center’s activities would decrease spending, but now realizes that they actually increased spending and likely will do so over the next decade as well.  The Center spend about $8 billion on its model projects and reduced spending by $2.6 billion.  My math may be fuzzy but that appears to be about a 3X negative return.  The original estimates were for about $10 billion in lower spending, which wouldn’t have been much of a return, but at least something.  The only model that generated any significant savings was one requiring prior authorization for repeated use of ambulance services for non-emergency situations.  There are a lot of patients who like to get free rides to the hospital by calling for an ambulance.  Why aren’t the great ideas behind these models successful?  Largely because they fail to account for human behavior and they lack mandatory participation or adequate incentives or penalties.  But the ideologues who run just about everything in the federal government won’t be capable of recognizing that.  (CBO Report)