Interestingly, a number of the delivery system reforms that are central to the Affordable Care Act’s cost saving strategies are showing up already. These include things like accountable care organizations (where providers form groups to lower costs through coordinating care, reducing duplication, avoiding errors), bundling payments (one payment for a full medical “episode” as opposed to separate ones for each provider), “medical homes” (assigning a primary doctor to coordinate a patient’s services), and financial incentives to reduce hospital recidivism.
Note that much of what we’re seeing here is the private sector trying out these measures even before the law has fully taken hold (and before the Supreme Court has announced its verdict on the ACA). So it’s a unique and positive interaction between pubilc policy and private practices in an area where we very much need these types of innovations. As I see it, the way forward for America involves fewer synthetic credit default swaps and more accountable care organizations!
Anyway, I hope such experimentation is why spending has slowed, but other evidence points to cost shifting onto to folks who can’t afford the services they need. That’s another way to bend the cost curve—a truly lousy way.