Should some version of healthcare reform be signed into law, I'd like to have a well-defined set of metrics to measure how successful it is at achieving its stated goals and objectives.
Clearly, a central objective is to increase the number of people with medical insurance. Democrats have bandied about the number 46 million as the current number uninsured, a number taken from a census bureau report. However, that number includes about 11 million illegal immigrants, who we are assured will not be covered. It also includes 15 million who were temporarily between coverages. The actual number of American citizens who are uninsured in the long term is around 20 million. Reducing that number significantly ought to be one metric. I would propose as a target that within ten years of Obamacare being enacted, the number of uninsured people be reduced to 5 million.
The percentage of America's GDP which is spent on health care is cited as a reason to reform our medical system. Obama has repeated that America spends 16% of GDP on health care, while Canada spends 10% of GDP and covers everyone. France spends 11% of GDP on health care. I propose 12% as a target.
Obama assures us that Obamacare will be deficit neutral, and that the public option will not be subsidized by the government. Measuring the deficit impact of a program is difficult. It is easy to falsely claim that costs have been offset by spending cuts if cuts are defined loosely. Stating that a program plans to increase spending by 10% and then only increasing it by 8% is not a 2% cut which can be used to offset Obamacare spending increases. Neither is the end of a short-term spending program a cut. For instance, the fact that we spent $800 billion on bailouts and stimulus this year and will only spend $300 billion next year does not equate to a $500 billion cut which can be used to offset Obamacare. Also, moving spending from one program to another is not a cut from the one. I propose this metric: for Obamacare to meet its goal of being deficit neutral, total entitlement spending must not grow faster than inflation times population growth. In addition, the public option (if included in the bill) must be self-supporting and not subsidized.
We are told that Obamacare will not reduce the quality of medical care in America. There is not one good metric for quality of medical care, so we have to track several metrics: infant mortality rate, life expectancy, and survival rates for various diseases all should do no worse than to continue on their current trend. "Quality-adjusted years of life" is a metric used by some countries. I don't fully understand how it works, but it sounds promising.
Obama campaigned on bringing transparency and accountability back to the political process. One way to accomplish that would be to build meaningful metrics into health care reform so that we will know if it delivers on the many promises made in the effort to sell the plan to the public.