PNHP

U.S. Seniors Experience Worst Cost Barriers to Care

The Commonwealth Fund just published a ten-nation survey of health care affordability for seniors. Guess who had the highest financial barriers to care? Yup, the U.S. Medicare helps (beats being young & uninsured or having massive deductibles), but needs lower cost-sharing.

Health Care Affordability for Older Adults: How the U.S. Compares to Other Countries, Commonwealth Fund, Dec. 4, 2024, by Munira Z. Gunja et al.

Like several other countries, nearly all adults age 65 and older in the U.S. have health coverage. But high out-of-pocket costs in the Medicare program may still make it more difficult for older Americans to receive affordable care compared to older adults in other countries.

Comment:

By Jim Kahn, M.D., M.P.H.

I just spent 3 days in Amsterdam, the Netherlands. Everyone seemed quite content. No wonder, given the extremely low prevalence of medical care cost barriers observed in this survey. Similar for most other nations included. The U.S. performs worst overall, by far, and worst or 2nd worst on each measure. Iā€™m beginning to think that uncertainty in the U.S. on medical care affordability is a major underlying cause of stress, anxiety, and the drive for political upheaval (more on that in a future post).

Now Iā€™m in Nairobi, Kenya, at a meeting about addressing dementia in low-income countries. These nations face huge challenges not only for treatment and care, but also for prevention programming. Because ā€¦ they have very little money. We in the high-income nations need to do a lot more to help them, and they should more emphatically prioritize heath in their budgets.

The U.S. doesnā€™t have the excuse of being poor. We have plenty of money ā€“ the most in the world. Our problem is that we build our massive health care system (fully 40% of global health spending) to benefit for-profit intermediaries and providers. This drives up costs. And insurance coverage is designed on the flawed premise of ā€œskin-in-the-gameā€ (empirically, it does not control costs). Lots of pain, no real gain.

Best practices, learning from successful approaches, following the leaders ā€¦ whatever phrase you prefer, itā€™s long past due for the U.S. to adopt proven practices from peer nations ā€“ to assure access while controlling costs.

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