Regardless of political leaning, most Americans can agree that the U.S. health care system is problematic. Per capita health care spending is nearly twice as high as that of other wealthy nations and the price of care continues to increase at a rate that far outpaces inflation.
Access to health care often varies based on income, race, age, sex, disability, gender identity and residential location. Cost, inadequate or no insurance coverage, and lack of availability of services are all barriers to health services that contribute to poor health status. In fact, the U.S. ranks alarmingly behind 11 other peer nations in terms of life expectancy, suicide rate, chronic disease, obesity, physician visits, hospitalizations from preventable causes and rate of avoidable deaths.
Health care administration is a nightmare for hospitals and private practices because of the complicated, variable mix of rules and regulations between private insurance companies, pharmacy benefits managers, employer groups, Medicare and Medicaid.
A 2017 study found that over a third of health care spending (about $2,500 per person) in the U.S. was attributed primarily to administrative overhead.
Clearly, health care reform is needed and there are a number of plans, proposals and bills currently being floated and discussed. These include:
Enhancing the Affordable Care Act.Creating a government-administered “public option” plan that would compete with private health insurance and be available to all Americans.Broadening Medicare eligibility by lowering the age to 60.And implementing a single-payer, improved Medicare-for-all plan.When evaluating these and other proposals for health care reform, it is important to remember that there are not likely to be any “perfect” solutions. Health care in this country is an enormous ship that is not going to be easy or quick to turn. Undoubtedly, sacrifices and compromises will be required, corrections and fixes may be ongoing, and there will be winners and losers in the health care industry.
In our opinion, what matters most is to first consider how any health reform recommendation addresses the problems with our current system. Specifically, ask these important questions:
How will it significantly reduce and control health care costs?What will the average out-of-pocket annual expense for health care be (payroll taxes, premiums, co-pays, deductibles, etc.)?How will it improve access to physician and hospital care?How will it improve the quality and efficiency of care and health outcomes?When evaluating a proposed solution, we think it is important to also look for whether it will provide:
Coverage protection for patients with pre-existing conditions.Lower prescription drug prices.Price transparency so it is known what a procedure or test will cost in advance.Protection from surprise billing from out-of-network providers.Protection for people who lose employer-sponsored health care.And protection against bankruptcy resulting from catastrophic illness/injury.Health care reform proposals typically include changes in the way and the amount we pay for health care. Comparing approaches requires an “apples-to-apples” perspective. We need to consider the sum total of insurance premiums, deductibles, co-pays, prescription drug purchases and other out-of-pocket expenses. We must factor in the federal and state tax dollars we currently pay that go toward health care services. Thirty percent of our federal taxes go toward financing government-sponsored health insurance – Medicare, Medicaid, the Children’s Health Insurance Program, veterans’ health care – as well as ACA insurance marketplace subsidies.
Finally, we believe it prudent to consider the impact health care reform will have on the health care industry as a whole. Most hospitals, private practices, insurance companies, pharmaceutical companies and medical equipment manufacturers are for-profit businesses that, in the case of public companies, exist to increase shareholder value. To the extent that health care reform will impact their bottom lines, they can understandably be expected to fight tooth and nail against reform.
Health care reform is coming and there will undoubtedly be much discussion and debate ahead. The challenge for citizens, stakeholders and elected officials will be to participate with nonpartisan open minds, a willingness to consider different perspectives and most importantly, a rational and thoughtful frame of reference for evaluating proposed solutions.
Jan and Greg Phillips own a marketing consulting firm and have been Durango residents for more than 30 years. Both have backgrounds in health education and health promotion and are actively involved in advocating for health care reform.