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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.”
Obamacare. It gets worse every year.
No $hit!
The people with the best & care are on Medicaid. All benefits no cost!
Free emergency room services for illegals and other poor.
Free health care for "dreamers" and migrants, including free "gender affirming" surgery for them.
People don't realize, the more "free" health care for one group, the more some other group has to pay for it.
They want socialized medicine and they don’t care how they get it.
We have created the worst of both worlds!
You get a “standard of care,” which is mostly defined by government: NIH, CDC, FDA, DEA.
But you get to pay premium for this flow charted junk health care since you have private for profit hospitals, insurance companies, big pharma, health care loan companies all maximizing their profits and gouging the customer.
***When you go to an American hospital you are signing a blank check!!!***
Even a used car dealer can’t play the games health care providers can in the US.
question all the lab tests...why?...
“Federal policymakers must fix it to ensure affordability,”
Every f up in the medical industry can be laid directly at the feet of bureaucrats and politicians “fixing” the healthcare industry. And where the hell are $2000 deductibles. The only garbage obamacare plans in my county have deductibles of $7000 with &14,000 “out of pocket” before they cover a penny of care.
Someone has to pay for the nv@ders free health care.
A revealing glimpse into the warped health perspective in this culture - "putting food on the table" is authoritatively juxtaposed with "caring for health". Reality: the food you put on your table is a huge part of how you care for your health.
Why don’t doctors compete on the open market, advertise prices, etc? Why don’t doctors tell you what tests, procedures, etc. cost before you agree to them?
That's the beauty of ObamaCare. You pay for it, but you never really get to use it!
There is no “open market”....government pays for 70% of healthcare. And there are dozens of prices for each service/procedure...the “retail”/cash payer price the Medicare price (usually about 20% of retail), the Medicaid price (even less than Medicare), the Blue Shield price, the Aetna price, the United Healthcare price, etc., etc. etc.. The privately insured pay extra to cover the reduced payments from the 70% of billing paid by the govt..
My bad...the govt. pays for about 65% of the population’s medical coverage/care:
https://crsreports.congress.gov/product/pdf/IF/IF10830
I had heard 70% mentioned somewhere but that is high.
The only garbage obamacare plans in my county have deductibles of $7000 with &14,000 “out of pocket” before they cover a penny of care.
That means your premiums are nothing more than a tax until you have a catastrophic health event.
All by design.
“Federal policymakers must fix it to ensure affordability.”
Please, no more Federal fixes. Those idiots screw up every single thing they touch.
L
With $900 monthly premiums for that $7000 deductible catastrophic coverage, there is a whole lot of taxation subsidizing the community.
I am quite familiar with a case where roughly $100,000 in Obamacare premiums over 12 years resulted in insurance paying for exactly two flu shots.
Cadillac insurance premiums for Yugo coverage. The government is here to help you.
Along with everything else.
NC insurance companies are proposing a 99.4% insurance increase for homeowners.
The ‘powers that be’ are purposely trying to price people out of owning homes.
The pre-tax HSA max contributions should, at a minimum, match the annual insurance deductibles.
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