Part of the problem with all this is people are not fully aware of the costs, and they also compare apples and oranges. When we were growing up, going to the doctors office was not expensive, and drug costs were relatively low, too. The range of lab tests were pretty small, the amount of care available by today’s standards was small, it was a different world. The major med most companies offered (including the one I had when I was first working 30 years ago) didn’t cover office visits, and was basically an 80% kind of deal, so if you got sick, you ended up paying a lot more. The managed care networks came about in part to encourage people to get preventative care and also came about because the old style plans costs were already soaring (in a managed network, doctors agree for a fee structure, in return for gaining access to a pool of people in that plan on a semi exclusive basis).
I can tell you that with employer plans, the costs have been skyrocketing, and while employers have shifted some of it to employees, a lot more of it, they still are bearing huge increases. ACA has been the excuse, but if you look at the cost of insurance coverage, it has been going up as huge multiples of inflation, when inflation was roughly 3%, premiums were going up 12% a year or more.
I have had older people on Medicare tell me that the rise in healthcare costs are greed, that medicare is so cost efficient, that it isn’t responsible for the increase in costs, without of course realizing that medicare is a kind of shell game, where the real cost of medicare is assumed by the broader pool of the insured, but not in an efficient way. It is socialized medicine where much of the cost in a sense is not paid by the medicare taxes we all pay, but rather in the form of a double tax by our premiums being increased because of cost shifting from hospitals and doctors to make up for the relatively little medicare pays.
Another thing I routinely hear is how it is no big deal that people aren’t insured, that a lot of them are younger people who don’t want it, people who don’t want it or don’t want to pay for it…the problem with that is they also don’t realize if that person gets sick, how much it will cost that system. That 20 something skateboard dude they used in some ads I saw for a health exchange if he fell and cracked his head (because he wasn’t wearing a helmet, naturally) will end up in the hospital, and someone pays for that, and it is mostly through cost shifting. That person who didn’t want to buy health insurance, thought it was a waste, when a family member gets sick, would be like the idiot who refused to pay his fire tax, then when his barn caught fire wanted them to put it out…
I agree with what others have said, it also is going to have to come down to costs and figuring out what medical care is appropriate. Funny one thing I haven’t heard mentioned, in the ‘good old days’, you never saw ads for prescription medicines, when you got sick your doctor decided what the best medicine was, and prescribed it. Now the airwaves are flooded with ads (and I am leaving out ‘lifestyle’ drugs like viagra and cialis, they already are rationed). Whether it is blood thinners, immune suppresants, arthritis drugs, drugs to cure hep C, cancer drugs, we are inundated with ads, whose whole purpose is to get people to use those drugs , even if they may not be needed, someone who has athritis who might be better treated with a low level anti inflammatory goes in wanting an expensive drug like Celebrex, because they saw the ads. I don’t know why prescription meds are allowed to be advertised like that, if we keep saying health care should be between a patient and a doctor, why are they allowed to do that? It ads to the cost of medical care, and it isn’t chump change.
There also have been plenty of studies that say that some ridiculous percent of health care is spent on maintaining the last month of life. It raises ethical questions and tough ones, but for example, is it good use of healthcare dollars when you have someone who is 85 years old with a late stage cancer, trying every procedure there is to put it in remission? If someone is in the hospital, and is constantly crashing and being revived with little hope of them every recovering, is keeping them alive like that good policy? Obviously, to the loved ones, it is, and it is a horrible choice to have to make, but if we are extending so much of our resources keeping someone alive the last month, should we be doing that? And yes, it is horrible, because who decides? If a parent has a premature child who has so many things wrong with them they are unlikely to live more than a couple of months, they will want to try and keep the child alive, for obvious reasons, how do you handle that, when the cost of keeping that child alive might be in the millions of dollars? These are issues our current system being so fragmented doesn’t handle, and what happens is these costs mount up, the bill goes to the person receiving care,they go belly up, then the provider recoups that by charging everyone else extra, which in turn drives up rates.
The real problem is people want easy answers when they don’t exist, and most of the solutions I hear are slogans. Saying “people need to be more responsible for their health care decisions” is a slogan, and one that is mostly untrue, given that when people are sick, they depend on doctors to give them appropriate treatement, saying “people should shop around for medical care” makes it sound like geting treated for medicine is like getting a car painted or getting your house renovated (and actually, unless people are foolish, taking the low bid on those kind of services is often not wise, you have to look at quality and such as well), would you go to the Earl Schieb cancer center, advertising “We can cure any cancer, 1995.99, guaranteed” or would you want to go to a place with an established reputation for beating cancer? I hear that people don’t realize the cost of medical care, it is too insulated from them, that they want ‘too much’, but the reality in this country is people find out the cost of medical care the hard way, when something bad happens…despite all the claims to the contrary, the single biggest category for financial distress and filing for bankruptcy is not credit cards, it is medical bills, and they learn about the cost in the school of hard knocks. One of the things ACA was trying to prevent was that, that people couldn’t be fooled that their supposed health insurance covered things and it didn’t through a bunch of exclusions. Health plans routinely were dropping people who got a catastrophic illness, and got away with it, ACA doesn’t allow that and other abuses, and with ACA, you know what the plans cover, they cannot for example suddenly refuse to cover liver cancer or leukemia because those are now required. In a sense, maybe ACA is now letting people know the real costs and the real issues of medicine.
I think the real problem is we are doing everything we can to patch together the existing system, which is held together with bailing wire and spit and chewing gum rather than coming up with comprehensive change that affects the whole system. What that is, or what is best, I certainly don’t know, I know 35 years ago this system was a mess, and most things that were done since then have turned out to be band aids. Put it this way, the health of people in the US is not a luxury IMO, health care shouldn’t be something that is a birthright of how well off you are, where you live, it is funny we talk about all the threats the US faces, whether it is economic competitiveness, the ability to defend ourselves, the threats to our quality of life, if you have a population that has poor healthcare, limited access to it, it likely is not going to be the kind of country we pride the US on being.