The headlines reporting the results of this Gallup survey are celebrating the decline in health care insecurity (e.g., “Fewer Americans Are Having Trouble Paying Health Care Bills, Gallup Finds” – Kaiser Health News). Although any improvement is always good news, a 17 percent decline in health care insecurity is not much to celebrate (declining from 18.7% to 15.5%). Filling the glass less than one-fifth full is disappointing when we could have had a full glass.
Although this paper is quite technical, the conclusions are straightforward. Health insurance makes expensive products and services affordable for patients and thus they will use them – a desirable policy outcome since patients will then receive the care they should have. But beyond that, by bundling services and products into the same insurance package, it allows monopoly manufacturers of high value products, such as expensive pharmaceuticals, to charge prices that exceed the value their products – an undesirable policy outcome.
Health care costs for the typical working family of four now average over $25,000 (2016 Milliman Medical Index). The only way low- and middle-income individuals and families can afford health care is through progressive redistribution. How are we doing?
AMA members understand that the financing of health care in the United States is highly flawed, even after implementation of the Affordable Care Act. Although the AMA’s official position has been to oppose single payer reform, it has become clear that it is time to take another look at various models of financing health care, including single payer.
Many European nations, in addition to having some form of universal or near-universal health insurance, also have optional voluntary health insurance plans (VHI). These have raised concerns about access, inequity, two-tiered care, queues, inefficient use of public funds, and the excess costs and inefficiencies due to greater administrative complexity. “Private insurers have not been seen as providing good value,” according to this report.
Since it is impossible to read all of the research studies on new drugs, we can be thankful that we have the Food and Drug Administration (FDA) to collate and evaluate all of that information so that we know that new drug products released on the market have been demonstrated to be both effective and safe. Or can we? This new study adds to our concerns.
It seems intuitive that value-based insurance design (VBID), such as requiring much higher patient cost sharing for low-value care (e.g., much greater out-of-pocket payments for “unnecessary” CT or MRI scans), should help reduce our total health care spending without inducing a major negative impact on health outcomes. But the authors of this study find that “increased cost-sharing may lead to modest increases in overall healthcare spending,” even though it may reduce utilization of some, but not all, targeted services.
Although this hearing was allegedly about programs for which spending is mandatory (such as Social Security and Medicare) and the failure of Congress to formally reauthorize public agencies and programs (such as the FBI and The State Department), it is really about the supposed need to cut spending in essential government programs. This process should be of concern to single payer supporters since, if we had a Medicare for All program, it would be on the chopping block as well.
One of the most important purposes of the Affordable Care Act (ACA) was to make health care affordable. After all, “Affordable” is in its name. This study reported by the Federal Reserve Bank of New York confirms that, indeed, health care has become more affordable for new enrollees in Medicaid, as confirmed by the decline in debt sent to collection agencies in states that did expand Medicaid. But that’s not the full story.
Outrageous! While the public drug abuse treatment centers decline in numbers, and the private, for-profit centers are proliferating, “the counties with higher percentages of black residents had a lower likelihood of having any outpatient facility by the end of the study period, compared to counties with less than the mean percentage of black residents” (Health Affairs).
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