By Helaine Olen
The Washington Post, July 5, 2018
The concept of “having skin in the game” is popular among those who still believe we can utilize the free market to rein in the cost of health care in the United States. The idea is that if people have to pay a decent percentage of the cost of medical care, they will turn into savvy medical shoppers when they need to see a doctor. This, in turn, will bring the costs down, ultimately resulting in a more affordable health-care system.
That’s the theory. The reality is different. Last week in Boston, Maria Cramer, a reporter for the Boston Globe, witnessed a horrifying accident on the city’s mass transit system:
Awful scene on the orange line. A woman’s leg got stuck in the gap between the train and the platform. It was twisted and bloody. Skin came off. She’s in agony and weeping. Just as upsetting she begged no one call an ambulance. “It’s $3000,” she wailed. “I can’t afford that.”
— Maria Cramer (@GlobeMCramer) June 29, 2018
A nurse who witnessed the aftermath of the accident said the victim most certainly needed an ambulance.
It seems almost beyond obvious to say that there is something cruel and out-and-out immoral about making people think about their financial skin in the game when their personal dermis is literally hanging off them. Other developed countries do not do this, and somehow they manage to spend less money overall on health care and often get better outcomes, too.
There is no real mystery about the United States’ sub-par performance. We are all but alone among developed countries in not offering universal health care. Most other comparable nations subsidize medical costs in some way or another, and they negotiate on behalf of all those they cover, too. Here we leave it to consumers, who despite having more and more “skin in the game” with each passing year still face increasing costs. More than 4 in 10 of those with private health insurance use a high-deductible plan, which means they are responsible for at least $1,300 in expenses before insurers will help with most of their medical bills.
The impact on household budgets is significant. According to a poll conducted earlier this year by the West Health Institute and Norc at the University of Chicago, 44 percent of those surveyed said they skipped visiting the doctor in the past year even when they thought they believed they needed the care, because of cost. Four in 10 also said they refused a doctor-recommended test or treatment because of the expense. More people said they were afraid of the cost of an illness than who said they were afraid of sickness itself. Another survey, this one by Ipsos for Consumers for Quality Care, found people more concerned about the costs of health care than those of college education, housing, child care or retirement. Cramer’s tweet demonstrates how this plays out in real time.
Little wonder. Costs are excessive, to say the least. Pfizer has raised the price of some of its pharmaceutical offerings by 20 percent since January of this year alone. Even the most determined consumer finds it all but impossible to price-check most medical services in advance, and that goes double in emergency situations. Surprise medical bills are a growing problem. Moreover, few know when they need a recommended procedure, further hindering their supposed ability to shop for health care. A study published last year in the Quarterly Journal of Economics of a firm where employees were switched over to a high-deductible health-insurance plan found that the workers and their families did indeed cut back on their medical spending — but they did it with seemingly no regard to need or quality.
Americans routinely say health care is one of the most important issues the country faces, and they have done so for years. When more than a few Democrats and Republicans responded to Alexandria Ocasio-Cortez’s surprise victory in a New York congressional primary by pointing out her support for Medicare for all would not play in other parts of the country, all they did was reveal how out of touch they are: Polls routinely find that a majority of voters support it. Many politicians are likely blinded to the reality of health care in the United States by money: The health-care industry is among the largest lobbies in Washington. A study by the nonprofit MapLight, which studies money in politics, found that Democratic senators who had not signed on to support Sen. Bernie Sanders’s Medicare-for-all bill received twice as much funds from the sector as those who attached their name to it.
Rising costs are shifting the health-care debate rapidly, and they would almost certainly would be doing so even if President Trump and the Republican Party supported the Affordable Care Act instead of ceaselessly undermined it. We are, I suspect, entering the end game for our free-market-dominated health-care system, shedding its skin, if you will, so we can regenerate it. Voters increasingly want no part of it. Doctors are increasingly likely to say they support a single-payer system. Insurance-company C-suite executives are known to claim they are open to discussing it, too. Even Trump, according to journalist Michael Wolff in his book “Fire and Fury: Inside the Trump White House,” asked after he was elected, “Why can’t Medicare simply cover everybody?” Why not, indeed.