drsmooth wrote:

Monkeyboy wrote:So then what would be considered evidence that the law is having a positive effect on costs and/or medical outcomes?

it will probably be hard to tot up the statute's impact on costs, and harder still to make political hay of cost savings successes or failures, for a few years, mainly due to the way effective dates of various provisions have been staggered over several years.

I just think it would be interesting to pin people down on this a bit. Otherwise, it will be one excuse after another why the evidence doesn't matter. Plus, it would just be good to know what to look for. I need to know my dependent variables, man

Werthless wrote:

drsmooth wrote:I'm not clear how obsessing on this whole health enrollment administrivia thing is something other than a surefire political loser

Yeah, Obama should talk about something else. It's certainly not making him look good to keep talking about it.

Quite right. Do quick updates, do the "brush lint off shoulders" move, treat it like no big deal, on to other things, let reactionary fruitcakes at Cato keep trying their pathetic "constitutional challenges" (which will do little but put Cato's output in the same dustbin that Heritage's shit currently lines), and Congressional scum like Issa beat their tiny fists on the rear bumper of the moving bus.

It's a loser

Anyone who ever has a thought of asserting that they have even a drop of conservative blood in their veins has to be very concerned about the court's ruling on Detroit employees' pensions. What you have to know now is that owning counts, and working ain't for shit.

Monkeyboy wrote:

drsmooth wrote:

Monkeyboy wrote:So then what would be considered evidence that the law is having a positive effect on costs and/or medical outcomes?

it will probably be hard to tot up the statute's impact on costs, and harder still to make political hay of cost savings successes or failures, for a few years, mainly due to the way effective dates of various provisions have been staggered over several years.

I just think it would be interesting to pin people down on this a bit. Otherwise, it will be one excuse after another why the evidence doesn't matter. Plus, it would just be good to know what to look for. I need to know my dependent variables, man

Welcome to macroeconomics, where pre-post comparisons are used as substitutes for actual knowledge. In other words, it's is impossible to ascertain what performance would have been without the law, so everyone can only make educated guesses based on trajectories. Even if you are using more advanced maths, no one can be conclusive. It doesn't matter if you try to "pin someone down on this." It's just as much art as science, when one is talking about forecasting with all of these externalities that aren't taken into account.

It's closer to science if you are looking at policies that were enacted in some states but not others; while the confidence intervals on these comparisons aren't very high due to all of the confounding variables that you can't possibly control for (eg. culture/attitudinal differences), it can still be more illustrative than saying "this is what it was before, and now this is what it is now." This is one of the reasons that I prefer leaving powers with the states; I love when states have different policies, because then you can observe how people react differently in the states. So if Texas has textbooks teaching evolution, you can point to outcomes over the next 25 years, and see if the Texan students have different life outcomes from, say, New Mexico students who learned with a more mainstream textbook.

yes, I get that. I know how to run an experiment. I do think, however, there are statistical methods in the social sciences for teasing out what is accounting for the variance.

But let's just say it's impossible to know what causes what. Does that also mean that any negative outcomes should be ignored or dismissed as unimportant? It just seems like you guys won't take any evidence as being worthwhile unless it's negative. It would be helpful to know what evidence of success you wouldn't reflexively dismiss. I'm also just curious what I should look for to gauge its success or failure. For example, I realize that correlation doesn't mean causation, but a reduction in costs in area X soon after a part of the law begins that's designed to reign in costs in area X is certainly suggestive. It's not proof, but a collection of similar results starts to add up absent some other explanation. I know it's tricky, but it's not like we don't have some tools at our disposal.

Monkeyboy wrote:It would be helpful to know what evidence of success you wouldn't reflexively dismiss.

Werthless wrote:If insurance prices on the exchange next year go up by <=5%, then that would likely be interpreted as a success. If they go up 10%, that would not be a success (IMO).

Like this post from last week?

How about that "since 2010, when the act was passed, real health spending per capita — that is, total spending adjusted for overall inflation and population growth — has risen less than a third as rapidly as its long-term average. Real spending per Medicare recipient hasn’t risen at all; real spending per Medicaid beneficiary has actually fallen slightly?"

Werthless wrote:

Monkeyboy wrote:It would be helpful to know what evidence of success you wouldn't reflexively dismiss.

Werthless wrote:If insurance prices on the exchange next year go up by <=5%, then that would likely be interpreted as a success. If they go up 10%, that would not be a success (IMO).

Like this post from last week?

Yes, that's a good example. Sorry I missed it.

What is a normal increase, just so I have some basis for comparison?

Werthless wrote:

Monkeyboy wrote:It would be helpful to know what evidence of success you wouldn't reflexively dismiss.

Werthless wrote:If insurance prices on the exchange next year go up by <=5%, then that would likely be interpreted as a success. If they go up 10%, that would not be a success (IMO).

Like this post from last week?

Changes in health insurance rates, on exchanges or otherwise, are not worth much as an indicator of just about anything, unless you're an individual policyholder trying to plan your household budget for the next coverage period. Insurers have already gimmicked-up rates going in, having little to no idea how to actually serve the waves of new customers they're being handed. Year 2 & 3 rates, and insurer participation, in exchanges can be expected to gyrate beyond the relatively narrow bounds Werthless has suggested. Insurer behavior in the early years of High Deductible Health Plans/HSAs may be instructive.

Exchange enrollment figures might be a sign of something, but maybe not other than "hey, this sure is a listless, jobless economic recovery we're having".

You might have to drop back to things like watching for signs that boutique COBRA administrators are going out of business, their clients having figured out that guiding their departing employees/dependents to exchange coverage over COBRA continuation coverage is probably the best move for all but a very small fraction of that group of people, as well as the employers themselves.

My indices of success would be signs of increased consumer scrutiny of need for care, and of prices for care when need is established, and of expansion of providers of care alternatives to traditional Marcus Welby channels of treatment. The problem there is those changes are already underway; ACA may or may not accelerate them.

I'd also be counseling Team Barry to go easy on claiming even indirectly that ACA has already had a positive impact on costs of care. Because, well, that evidence is spongy. I hope that's true, but I sure do not know that's true. And neither do the people making noises like that. Yeah, including Obama himself. And it could be worse; you might only be flattening costs while also "flattening" health. The early information is promising - that cost increases are slowing without impinging on health quality - but it's hardly conclusive.

Monkeyboy wrote:

Werthless wrote:

Monkeyboy wrote:It would be helpful to know what evidence of success you wouldn't reflexively dismiss.

Werthless wrote:If insurance prices on the exchange next year go up by <=5%, then that would likely be interpreted as a success. If they go up 10%, that would not be a success (IMO).

Like this post from last week?

Yes, that's a good example. Sorry I missed it.

What is a normal increase, just so I have some basis for comparison?

dunno about normal, but here are year-over-year increases in the cost of covering single employees that self-funded employers reported to Kaiser Family Foundation over the past decade (ok, from 2000-2013):

2000 8.7%
2001 10.0%
2002 14.7%
2003 8.4%
2004 8.4%
2005 11.2%
2006 5.6%
2007 4.6%
2008 6.9%
2009 0.9%
2010 4.1%
2011 9.1%
2012 2.5%
2013 6.4%

Self-funding employers aren't paying premiums to insurers, so their changes are probably a closer indicator in changes in actual costs of coverage than insurers' premium rates, which can and do reflect, uh, other forces at work.

But you can see from this progression of figures at least one difficulty with werthless' suggested range of rate changes that might spell success or failure. To reiterate, it's too narrow. But more than that; rate changes as a measure of success or failure is probably a non sequitur

Ok, so I didn't understand parts of those two posts, but I think I got the gist. Thanks for taking the time to explain it. I've economically challenged since I was a child.

So you're one of the 47%, huh?

drsmooth wrote:What you have to know now is that owning counts, and working ain't for shit.

But, drsmooth, unions are ruining America.

Monkeyboy wrote:Ok, so I didn't understand parts of those two posts, but I think I got the gist. Thanks for taking the time to explain it. I've economically challenged since I was a child.

I share your desire for having a means to evaluate the success of a program. We always run the risk of "looking where the light is," and evaluating success based on a metric simply because it is measurable. That quoted discussion was around the impact of the website glitches on enrollment. In this particular case, just as in the broader case of overall ACA impact, there is not one number one can use. Is it number of insured? Change in average cost of healthcare? Outcomes? Change in growth rates of healthcare costs?

If prices on the individual market surge next year, then that would be evidence that the risk/cost of that group was worse than anticipated. That's not an indictment of the entire law, but suggestive that the poor rollout resulted in a higher than expected risk. I tried to put some numbers around it, but it's open to opinion, and the cost itself will be influenced by other exogenous factors.

Werthless wrote:If prices on the individual market surge next year, then that would be evidence that the risk/cost of that group was worse than anticipated.

weak evidence, unreliable evidence, but evidence, of .... something. Kind of like a wet finger in the wind, but with a considerable amount of the wetness coming from orifices you may not want me to mention

i like that doc says he'd be advising the pres/dems to not take credit for slowing healthcare costs and werthless says "If prices on the individual market surge next year, then that would be evidence that the risk/cost of that group was worse than anticipated"

My brain is fried. Explain?

just that it won't really be "evidence" of anything either way, whether we see a dip in costs or a surge. doc put it more eloquently than me

drsmooth wrote:weak evidence, unreliable evidence, but evidence, of .... something. Kind of like a wet finger in the wind, but with a considerable amount of the wetness coming from orifices you may not want me to mention

JFLNYC wrote:So you're one of the 47%, huh?

Yup, we were dirt poor until I went away to college. Then my mother remarried and got her nursing degree. Now they are upper middle class. We're a family of late bloomers.