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What Has Obama Done, Anyway?

When I read this quote, from a New York Observer story about disillusioned pro-Obama hipsters...

Mr. Mahfouda said that the flag is now in his living room and hasn’t been unfurled in over a year. There are no immediate plans to bring it back out again for 2012.
“My intuitive response is that [Obama] hasn’t done a ton,” he said. “He hasn’t really rocked the boat too much.”

...I was reduced to stammering incredulity, like Ferris Bueller when Cameron told him they hasn't seen anything good:

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Ferris: Cameron, what have you seen today?
Cameron: Nothing good. 
Ferris: Nothing - wha - what do you mean nothing good? We've seen everything good. We've seen the whole city! We went to a museum, we saw priceless works of art! We ate pancreas!

You can look up your own list of all the things Obama did. (Here's a clip from Rachel Maddow.) Whether or not you think it's enough, it is, by any historical standard, a lot.

One of the things I noticed is that lists of liberal accomplishments tend to totally ignore health care cost containment.The Affordable Care Act was an attempt to do two things at once -- cover the uninsured, and tame runaway health care inflation. The latter goal was a crucial administration priority, but it never attracted much liberal passion in Congress, because most Democrats either saw it as unpopular, coded it as "centrist," or are in the pockets of interest groups that profit from wasteful spending. Meanwhile, centrists purportedly concerned with taming health care inflation maintained their centrist credibility by denouncing the bill as failing to go far enough.

So the vital goal medical inflation restraint mechanisms, and Peter Orszag notices some early signs of success:

And now for some good news: Medicare spending growth has been slowing noticeably. So far this fiscal year, expenditures have actually declined slightly, according to the Congressional Budget Office.
Part of the decline this year reflects timing shifts in certain Medicare payments, which will soon be reversed. Even adjusting for these shifts, though, Medicare spending is still up less than 4 percent so far this year.
The 2011 numbers come on the heels of relatively slow growth in 2010 as well. Last year, Medicare spending rose just a little more than 4 percent.
Compare this with an almost 12 percent average annual growth rate in Medicare spending since the early 1970s. During those four decades, there were only four years in which costs rose by less than 5 percent -- and three of those four years were in the late 1990s, when payments were cut back as part of the 1997 budget deal.

Is it the recession? Probably not, writes Orszag:

Medicare’s growth slowdown has been much greater than that of private health insurance, however, as Maggie Mahar has noted on the Century Foundation’s Health Beat blog. In the 12-month period that ended in June 2011, Standard & Poor’s index for commercial health insurance rose 7.5 percent, while its Medicare index rose only 2.5 percent. The S&P data show that Medicare spending growth has been falling fairly steadily over the past 18 months.
So why are we seeing an especially rapid decline in Medicare growth?
The Mount Sinai experience may be instructive. From September 2010 to May 2011, the hospital’s Medicare revenue rose only 2 percent over the previous year -- in part because the number of inpatient cases fell. Why was that? One important reason was that the number of patients readmitted to the hospital within 30 days of discharge was 5 percent less than what it had been the previous year.
Reducing readmissions is one of the objectives of the federal health-care-reform law enacted last year. Historically, nearly 20 percent of Medicare patients have been readmitted to a hospital within 30 days of being discharged, in part because their doctors and other health-care providers have not managed patient handoffs very effectively. The Affordable Care Act included, among other remedies, a modest penalty for hospitals with high readmission rates.
At Mount Sinai, patients at risk of rehospitalization are now identified when they first come in and assigned to a special team of doctors and nurses that works to minimize that risk. Apparently, the effort is working. And as more hospital systems begin to use information-technology systems to measure and manage value, we could see progress in other areas of patient care as well.

I do think the Affordable Care Act's many cost containment experiments, assuming they survive the political assault that is already taking place, will go down as one of the most important policy reforms in modern American history.