Tuesday, January 7, 2014

Robert Pear at the New York Times offers a clear summary of a recent report by civil servants at the Medicare agency: "National health spending grew slowly for the fourth consecutive year, increasing 3.7 percent in 2012 to $2.8 trillion."

“The relatively low rates of growth that we’ve seen over the last four years are consistent with the historical trends that we’ve seen when we look at health spending and gross domestic product,” said Aaron C. Catlin, an economist and co-author of the report. “It’s consistent with what we’ve seen in post-recessionary periods in the past.” 

Nonetheless, the Administration was all too quick to jump in with its interpretation:

[T]he White House said the data vindicated President Obama’s health care policies. 

“The years 2009 to 2012 saw the slowest growth in U.S. health care expenditures since the government started collecting this information in the 1960s,” said Jeanne M. Lambrew, a health policy coordinator at the White House. 

“While there is a debate about how much the Affordable Care Act has contributed to this health cost slowdown,” Ms. Lambrew said, “there is no doubt that it reduced Medicare spending growth, and most experts believe that Medicare savings spill over into the private sector.” 

Most experts?  None that were quoted by this excellent reporter.  In fact, Medicare spending in 2012 grew faster than overall spending, at 4.8%.  Recall that the 3.7% total growth in spending includes the Medicare amount, so everything-but-Medicare grew at a rate well below Medicare. (Medicare represents about 20% of national health spending.)*

Oy. Why do they feel they have to claim credit? As noted:

Some provisions of the new health care law increased spending and others reduced it, but the overall effects on spending were modest, said Anne B. Martin, an economist who was the principal author of the report. She estimated that the law had increased national health spending by a cumulative total of one-tenth of 1 percent from 2010 through 2012. 

Read on:

Spending on hospitals and doctors increased at a faster rate in 2012 than 2011, while spending on prescription drugs and nursing homes grew more slowly. 

Hospital care increased 4.9 percent in 2012, compared to 3.5 percent in 2011. Spending for doctors’ services and outpatient clinics grew by 4.6 percent in 2012, up from 4.1 percent in 2011. 

"Spending for prescription drugs grew just four-tenths of 1 percent in 2012 compared to 2.5 percent in 2011." Why?  "Numerous brand-name blockbuster drugs — most notably Lipitor, Plavix and Singulair — lost patent protection in late 2011 and in 2012 and generic versions became available. Generic drugs accounted for 77 percent of all prescriptions filled in 2012, up from about 70 percent in 2011."

You just have to look at the chart above to understand that there are cycles in the rate of change of health care spending.  For an administration to claim credit for a dip in the rate is simply an exercise in over-reaching. It also makes that same administration responsible for any upward tick as the ACA goes into full swing.  I don't imagine we'll hear much from them on that at this time next year.

Speaking of next year, why does it take over a year to compile these figures?  Why are we looking at 2012 numbers?  The bills for 2013 will be paid by February.  Let's see if we can get these reports to be more current, so there is less tendency to "drive using the rear view mirror."

* Also, recall that Medicare spending has two components.  One is utilization, which is driven by demand.  The other is price, which is set administratively--irrespective of the actual costs of delivering services. It is important to know the relative weights of the two factors when looking at overall changes.


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