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Posted on 01/11/2024 10:30:49 PM PST by SeekAndFind
Millions of Americans are struggling under the crushing weight of rapidly rising health care costs that now force them to choose between putting food on the table or taking care of their health.
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Even with insurance, medical bills have become backbreaking as health care expenditures devoured more than 17 percent of the U.S. GDP, an increase of 4.1 percent from the year before.
Over the past few decades, health care expenditures in the United States have skyrocketed.
Costs rocketed to nearly $4.5 trillion in 2022 despite reduced services during the pandemic, data from the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program, show. The agency predicts national health expenditures will soar to nearly $7 trillion by 2030.
Out-of-pocket costs will also increase by an average of 4.6 percent annually through 2030 to reach 9 percent of total spending.
Deductibles also show a worrying trend, with the average deductible doubling from $1,025 in 2010 to $2,004 in 2021, according to the Center for American Progress, a public policy research and advocacy organization. In the same time frame, the percentage of plans mandating a deductible rose from 78 percent to about 89 percent.
As a result, even those with insurance often cannot afford the out-of-pocket expenses associated with needed care. The problem is especially acute because incomes have failed to keep pace with rapidly rising costs.
Why are people with health insurance increasingly faced with high medical debt? Is it a problem with health insurers or health care providers?
It’s both, according to Pavani Rangachari, a professor of health care administration and public health director of the Master of Healthcare Administration program at the University of New Haven in Connecticut.
The root cause is a broken health care system, “the way it is designed, unfortunately,” she told The Epoch Times. Federal policymakers must fix it to ensure affordability, “They have a big role to play in modifying the system to ensure that it works well for people who are insured.”
A Federal Reserve survey found that, in 2022, about one-third of U.S. adults recently skipped or postponed medical care due to cost. The most frequently delayed care was dental, with 21 percent skipping dentist visits, followed by a visit to a specialist, with 16 percent saying they did not go.
Other care avoided due to costs include the following:
Lower-income patients suffered most: 38 percent of those earning under $25,000 went without some care due to expense, versus 11 percent of those earning at least $100,000.
Data from The Commonwealth Fund, a health care policy-focused private foundation, reveal nearly half of lower- and middle-income adults reported at least one affordability issue accessing care in the past year.
One factor contributing to the increasing unaffordability of care is due to the equation “price times quantity,” Ms. Rangachari said.
Providers can charge substantially higher rates for the same services to private insurers versus public plans like Medicaid, Ms. Rangachari said. This allows them to negotiate selectively. For example, they may deny care for lower-paying Medicaid patients if reimbursements are deemed insufficient. This leaves uninsured and lower-income patients with fewer affordable options.
“You have all of these different market segmentations, so the people who are able to afford it and might not really need that kind of preventive health care are benefiting from it,” Ms. Rangachari said. Additionally, those most in need of care face coverage denials.
The quantity side of the affordability equation involves overused services, Ms. Rangachari said. Much unnecessary testing stems from fee-for-service models compensating volume over value. Each test, procedure, or patient visit triggers a separate payment.
This has led payments to be based on volume rather than value, incentivizing unnecessary services over preventative care, she added. This has driven health care spending to nearly 20 percent of GDP according to the CMS, an economically unstable trajectory signaling a need for health system reform, Ms. Rangachari noted.
Value-based care is one solution for repairing issues in the system, according to Ms. Rangachari. This model emphasizes patient outcomes over fee-for-service.
“One big example is bundled payments for episodes of care, rather than just focusing on encounter-based care and paying for every service delivered,” she said.
Programs like CMS’ bundled payments for joint replacements focus spending on total 90-day care rather than single encounters. This prevents emergency readmissions from fragmented or poor care, Ms. Rangachari added, noting this approach could extend to prescription drugs.
Pharmaceuticals also bear the blame for health care’s cost spikes.
A 2023 AARP analysis found list prices had more than tripled since their introduction to the market. To fight these price hikes, the Inflation Reduction Act enables Medicare to negotiate lower prices and limit out-of-pocket costs for beneficiaries. (The act’s provisions don’t extend to the private health insurance market.)
Applying value-based purchasing here could control pricing and supply issues, Ms. Rangachari said. CMS will increasingly scrutinize what value is delivered to justify cost, comparative efficacy, therapeutic advances, and research and development investments.
“And this is an initiative that’s now underway as a result of the Inflation Reduction Act,” Ms. Rangachari said. “Ultimately, it’s really tackling the p’s and the q’s of the equation through delivery system reform.”
Too many “people” riding the cart and too few doing the pulling.
I just paid a $300 deductible for a CT scan.
For sure ... I am living proof of that
The people with the best & care are on Medicaid. All benefits no cost!
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Not true.
Medicare only covers 80%. Most procedures have a copay even with Advantage plans.
The only group that gets Cadillac coverage are Unions and government.
My CT Scans cost me $280 each under a Medicare Advantage plan, without which it would have cost me >6 thousand dollars
The more free health we have, the more it costs everyone else. When Medicaid expands, someone has to make up the difference.
I have a supplemental plan that pays its part of the 20% if the procedure is medically necessary. IOW no co pay. Not an Advantage plan or Medigap. It’s a Plan F. Never had to pay a cent and no copays if the doctor says I need it.
I had cardiac bypass surgery this summer, cost me about $6k out of pocket. Total cost of surgery and hospital stay about $700k.
Medicare and Medicaid are different
In theory true, but it’s getting harder to find practices that accept Medicaid, and wait times are getting very, very long.
And what is really the important crux in the matter is that you are not dead.
The $6k can be amortized over the rest of your life.
In addition, feral giverment has been reducing reimbursement for health care as the baby boomers were forced and flooded into medicare, thus shifting the costs to “the market” and the insurers pass costs on to their insured.
Also, US citizens pay higher Rx prices to subsidize lower RX prices mandated by other countries.
There is only one way that this will change significantly. Total healthcare system collapse. We are a long way from there b/c there is too much money yet to be taken, and too much power left to grab. Politics abhors a power vacuum. I point out the article shows that people are self-restricting their own care due to costs. The ferals will eventually impose those restrictions too, and will even use social credit scores to determine eligibility.
Your Plan F is a Medigap supplemental policy, no longer available to new enrollees since 2020. The closest Medigap plan available for enrollment today is Plan G, which does not cover the Medicare Part B deductible. Plans F and G also have the most expensive monthly premiums for Medigap supplemental policies.
I had it since before I retired and continued it on into retirement, and it’s always paid everything of the leftover 20%.
I’ve paid no copays for office visits nor have I ever been billed anything for any of the times I’ve been in the hospital since retiring (4 times). It is very expensive but plannable and manageable and I don’t have to worry about what ifs....
It is set up now that physical therapy has to come before treating you any other way for a bad back or whatever. For most it is a waste. Particularly for old people.
How much do you pay monthly for that plan?
The truth is that those who resist PT are just lazy. Being lazy and perhaps ignorant as well, they are unwilling to put forth the mental and physical effort to engage in PT and required follow up.
The primary complaint of PT therapists is that people who could benefit lack the will to even try to help themselves. This is especially true of old women
Little over $300 but my retirement package from work pays for it. My medical bills since retirement have far, far exceeded that - greatly.
The Democrats hope to destroy a once solid system and refuse to make improvements. They want it to blow up, they want socialized single payor.
I’ll be going with Plan N. It requires $20 co-pays for office visits. With $500 annual premium savings over Plan G, I would have to pay for 25 office visits per year at $20/visit before matching the Plan G premiums. I can live with that.
I am not against it. I have had it maybe more than most.
My bone of contention is that we are forced to do something that in many cases does not work or isn’t the root of the problem.
Our choices are no longer OUR choices.
I ususally don’t catagorize people in pain with a broad brush that they are lazy if they don’t do well with physical therapy.
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