The medical bill score: How the public judges health care

By Drew Altman
Axios, October 3, 2017

We track a lot of numbers in health care: how much we spend on health as a share of our economy; the number of uninsured; and the share of the federal budget allocated to health programs. What we don’t track — and a number the Congressional Budget Office cannot score — is the statistic that means the most to the American people: the share of the public having problems paying their health care bills.

Percent saying they have taken action in order to pay medical bills:

72% – Put off vacations, household purchases

70% – Cut back on food, clothing, basic items

59% – Used up all or most of savings

41% – Taken an extra job or worked more hours

37% – Borrowed money from friends or family

34% – Increased credit card debt

26% – Taken money out of long-term savings

17% – Changed your living situation

15% – Taken out another type of loan

13% – Borrowed from a payday lender

12% – Sought aid of a charity or non-profit

02% – Taken out another mortgage

15% – Made other significant changes

The bottom line:

The “medical bills score” is the single most important measure of how we are doing in health care from the public’s perspective. And ultimately, if Congress ever passes a new health care bill, it is how the public will evaluate that plan — from Graham-Cassidy to Medicare for All and everything in between.

The numbers that matter:

As we found in a Kaiser Family Foundation poll in February:

* 31% of Americans age 18-64 report they or a family member face problems paying their health care bills.

* But that number shoots up to 57% for people who are sick.

It makes sense that people who use more care have more health care bills, but it also reveals how poorly our system performs from a consumer perspective when people who need care the most are protected the least by insurance coverage.

The impact:

Not surprisingly, the uninsured (41%) are more likely to have problems paying medical bills. But this is not a problem limited to the uninsured: 30% of the insured – think voters — have problems with medical bills.

The back story:

The share of the public reporting problems paying their medical bills has not moved much in recent years. The Affordable Care Act has extended coverage and better financial protection to tens of millions, but it doesn’t have much of an impact on affordability beyond people covered by the Medicaid expansion and the marketplaces.

In the far larger employer-based health insurance sector, deductibles and other forms of cost sharing have been growing about five times faster than wages, and deductibles have been growing especially sharply for people who work for smaller employers.

What to watch:

Health care is a pocketbook issue for most of the public and the American people have their own scoring system. They may give this or that mostly partisan response about a health reform idea on a poll, but until they see how they’ll get help paying their health care bills, they will ultimately be disappointed by every health reform plan.…

“Yes, but how will health care reform affect me?” For most people that means, how much will I have to pay for my insurance, and how much will I have to pay out of pocket for my health care?

Except for low-income individuals with heavily subsidized insurance, members of the work force are paying too much for their insurance, either directly or through forgone wages, and they are paying too much when they need to access health care, especially through high deductibles.

Under the Physicians’ Proposal – a single payer model advocated for by Physicians for a National Health Program – insurance premiums would be eliminated and replaced by equitable funding  of a universal risk pool that would be affordable for each of us, and deductibles and other cost sharing would be eliminated for all essential health care services since other, more patient-friendly methods of cost containment would allow the removal of financial barriers to care.

As Drew Altman states, “until they see how they’ll get help paying their health care bills, they will ultimately be disappointed by every health reform plan.” The obvious lesson is that we need to show the public how a single payer, improved Medicare for all program will give them the “medical bill score” they have been looking for, and thus end the scourge of medical debt.

A Physicians’ Proposal for Single-Payer Health Care Reform:

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