The Economist March 24th 2012
United States; 51
Obamacare at two
No matter what happens to Saraek Obama's Jaw, American health care is changing rorgood "HELEN R. ~ is an elderly woman who is currendy on seven different medications. Thanks to Barack Ohama's health reforms, however, she gets cheaper medicine and cancer tests. "The health-care law is about people like me," Helen R. explains in a new video on a government website. Republicans may deride the health law as "Obamacare." Helen R. prefers to call it "Helencare". Mr Obama's health reform turned two years old on March 23rd. The White House is doing ils best to sell it as a success. The video of Helen R. is one of many. The Department of Health and Human Services (HHS) releases sunny data almost daily. But the campaign still feels defensive. There are good reasons for that: ...view middle of the document...
Big rallies will coincide with the Supreme Court's argu· ments, but the furore belies an increasingly obvious fact. American health care is changing, possibly for good. thaI is nOl because the law's implementation has been smooth. In October Mr Obama scrapped an impractical insurance plan to pay for nursing homes and other long-term care. A fight over the provision of contraception has dragged on and on. And one of the law's biggest measures is also one of its shakiest. State exchanges, where individuals will buy insurance, must open by 2014, when the mandate comes into force. States are making slow progress. Some governors shun the exchanges as a matter of principle. Others are waiting for more information. On Marchllth HHSissued new regulations for the exchanges. Yet even 644 pages of rules left unanswered questions, including what exactly insurers have to cover. Despite all this, HHS is continuing the slow work of implementation. Thanks to the reform, children up to the age of 26 can stay on their parents' insurance. Discounts and drug rebates have saved the elderly $3.2 billion on prescription drugs. Insurers must devote at least 80% of their fees to medical care, instead of to administrative costs or margins. From September, they will have to descrihe their products in a clear, comparable manner. More interesting, and important in the long term, are the reforms that start to change the structure of health care. Ameri' ca rewards those who provide lots of care, not those who keep patients well. The result is costly and inefficient. Mr Obama's law mainly tackles a symptom of this pro· blem: that millions of Americans cannot afford insurance. But the law also tinkers with health care's perverse incentives. fiRS has launched a programme to re-
A glimmer of nope
Pt!rcertt3ge dlange on previous ye~r'
70 75 80 85 90 95