By Drew Altman
Axios, August 20, 2018
Share under age 65 who were uninsured or had problems affording care in 2017:
All people – 26.2%
15.5% – Insured but struggled with affordability
10.7% – Uninsured
People in fair or poor health – 46.4%
32.9% – Insured but struggled with affordability
13.5% – Uninsured
We still have an uninsured problem in the U.S., but we have a far broader health care affordability problem that hits sick people especially hard.
Why it matters: It’s time to think more broadly about who’s having trouble paying for the health care they need. The combination of lack of insurance and affordability affects about a quarter of the non-elderly population at any one time, but almost half of people who are sick.
Now that the Affordable Care Act has expanded health coverage, the percentage of the non-elderly population that is uninsured is now just under 11%, the lowest level ever recorded. But as the chart shows:
* Another 15.5% who have insurance either skipped or delayed care because of the cost or reported that they or someone in their family faced problems paying their bills in 2017.
* That brings the total percentage of non-elderly people with insurance and affordability problems to 26.2%.
More striking: nearly half of all people in fair or poor health — 46.4% — are uninsured or have affordability problems despite having coverage.
* That includes 13.5% who were uninsured and in fair or poor health — arguably the worst off in the entire system — and another 32.9% percent who have insurance but said they or a family member have had a problem affording care in the last year.
It’s not surprising that people who are sicker and need more care would have more problems paying for it. But arguably an insurance system should work best for people who need it the most.
All this says a lot about current health care politics.
* It helps explain why so many people name health their top issue, despite the progress that has been made in covering the uninsured. And everyone who’s sick and can’t afford medical care has family members and friends who see what they are going through, creating a political multiplier effect.
* It is also why health care is substantially an economic issue as well as an issue of access to care. When people have trouble paying medical bills, it’s a hard hit to their family budgets — causing many people to take a second job, roll up more debt, borrow money, and forego other important family needs.
For as long as I have been in the field, we have used two measures more than any others to gauge the performance of the health system: the number of Americans who are uninsured and the percentage of GDP we spend on health. Both measures remain valid today.
The bottom line: If we want a measure that captures how people perceive the system when the number of uninsured is down and overall health spending has moderated, we need better ways of counting up the much larger share of the population who are having problems affording care.
And whatever big policy idea candidates are selling, from single payer on the left to health care choices on the right, the candidate who connects that idea to the public’s worries about paying their medical bills is the one who will have found the secret sauce.
By Don McCanne, M.D.
More boring numbers. But wait. These may be the most important numbers of all when we look at how our health care financing system is working. For the very people that our system should be designed to help – people in fair to poor health – it is not working well for nearly half of them!
Think about that.
When you need health care, the deductibles may create a financial barrier to care, potentially impairing access or creating a financial hardship.
When you need health care, the insurance premiums may be unaffordable and you end up uninsured, potentially creating an even greater financial hardship along with impaired access to care.
When you need health care, the insurers have likely limited you to physicians and hospitals that they have selected for their networks, preventing you from obtaining what may be more appropriate care outside of their networks, not to mention creating a greater financial burden when care outside of the network is unavoidable.
One-fourth of people under 65 are uninsured or struggle with affordability of health care.
But the most damning feature of our health care financing system is that nearly one-half of people under 65 who are in fair to poor health are uninsured or struggle with affordability of health care. This is a crisis that necessitates replacing our current costly but highly dysfunctional health care financing system with one that actually works – a well designed, single payer, improved Medicare for all.
This is an emergency. People are suffering, some are facing financial hardship or even personal bankruptcy, and others are dying!
We do not need more money. We are already spending enough. We merely need to restructure the financing system so that it is both universal and equitable in removing financial barriers to care. That is exactly what a single payer system is designed to do.
The clincher? Drew Altman reminds us that we have a choice between “single payer” and “health care choices.” Well, that’s not quite accurate because it is single payer that allows free choices in actual health care services whereas it is the insurers that give you choices of insurance products as they take away your choices in health care.
Altman’s challenge to find the “secret sauce” that addresses the public’s worries about paying their medical bills is the easiest challenge we’ve faced. Contrast the moral imperative of the single payer model, which brings affordable care to everyone, with the insurance industry’s “health care choices” – their deceptive euphemism for choosing a product from their highly profitable market of private insurance plans, even though they are not serving the interests of one-half of people under 65 who are in fair to poor health – the very population that an ethical health care financing system should be targeting.
This is a really simple concept that everyone should be able to understand. Share it widely.
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