Aaron Carroll on Being a Doctor
Paul Van de Water on Budget Arithmetic:

Department of "Huh?": Republicans Are Making a Big Fuss About How Medicare Actuary Rick Foster's View of the Affordable Care Act Differs from that of Doug Elmendorf

But I don't see it. I really don't see it.

Here is the CBO score of the Affordable Care Act:


Here is Medicare actuary Richard Foster's score of the Affordable Care Act:


These look like very much the same numbers--except that Foster's table is missing the "other provisions [of the ACA] affecting revenues" line.

Foster is marginally less optimistic about the Affordable Care Act than Doug Elmendorf and other economists like me are. Actuaries like Foster tend to assume that people do not change their behavior in response to incentives, hence we economists view their estimates with enormous skepticism.

Foster's big complaint with ACA is not that the policies won't reduce costs but rather that Congress will repeal the policies that save costs: that they are not "sustainable":

Compared to prior law, the level of total national health expenditures is estimated to be higher through 2019 under the Affordable Care Act, but two particular provisions of the legislation would help reduce NHE growth rates after 2016. Specifically, the productivity adjustments to most Medicare payment updates... the excise tax on high-cost employer health plans....

Although these growth rate differentials are not large, over time they would have a noticeable downward effect on the level of national health expenditures. Such an outcome, however, would depend critically on the sustainability of both provisions. As discussed previously, the Medicare productivity adjustments could become unsustainable even within the next 10 years, and over time the reductions in the scope of employer-sponsored health insurance could also become an issue. For these reasons, the estimated reductions in NHE growth rates after 2016 may not be fully achievable."

To say that the Affordable Care Act will in the end not reduce costs because doctors will successfully lobby Congress to repeal some of its provisions in order to make their incomes from Medicare grow more rapidly than the ACA permits might welk be true.

But I don't think that is an actuarial judgment.

And if it were one would have expected doctors to lobby Congress not to pass the ACA in the first place.