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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.”
Yes.
I noticed, since the Obamacare kicked in, the healthcare went down drastically.
The appointments, which used to take days, take now months!
And the costs are skyrocketing!
Something is clogging the system.
I haven’t had insurance since Obamacare made my catastrophic plan illegal. It was $200 a month, for the 3 of us, 10,000 deductible and No Copay. $2 million cap per. So I have always paid for the basic stuff myself.
I have been going to same doctors office for almost 40 years now and I usually just pay an office visit of $125 for everything I need, sometimes a little more depending but always $500 or less. Last time I got stitches it was $500, but if I had insurance the office billed the insurance company $3500 to get their $500 in the end.
I managed to lower my income significantly last year and signed up for Obamacare at $122 per month with $7k deductible for each of us. It started a week ago. I will NOT USE IT for normal crap that happens and instead will do what I have always done, PAY CASH to my Doctor.
I recently got a blood clot in my knee, when all was said and done, it cost me $2500 with No Insurance, but my Hospital has different prices depending on who is paying the bill and they LIST IT on the Bill. If I had Insurance they would have billed around $12,000 to get that same $2500 and it would have cost me $7,000 to satisfy the deductible and because of my normal income, the premiums would have been $1100 a month.
If you do the Math under Obamacare it would have cost me 20,000 to get $2500 worth of medical care.
We have the best insurance plan that is available to us through my wife’s job. It’s pretty expensive. She works in an oncology clinic in the laboratory. That being said, our deductible is $3,000 and it just restarted on January 1st. I am a cancer survivor, but I still take immunotherapy meds, along with all of my other meds. I’ll hit the $3,000 deductible before January is over. We literally have to set aside money all year in anticipation of this. It sucks. Then I see these commercials adverstising 0bamacare where some guy says, “My gov’t insurance is only $30/month” but then you see in very fine print the two words, “with assistance.” Wish I could get some “assistance” with our insurance, but apparently we’re “priveledged.”
IF there were not so many non-stop ads on TV telling people about this or that & the medications:
Would people stop being so PARANOID about their own health?
YOU “MIGHT” have this...
YOU “MIGHT” GET THAT...
PAY MORE ATTENTION TO YOUR OWN BODY-—Quit being scared into non-stop exams & medications.
I have not had any prescriptions for over 20 years.
DO NOT have a “GP.”
DO NOT HAVE a ZILLION “Appointments” on my calendar for this doctor or that doctor.
Had cataract surgery 6+++ years ago.
Had Dental surgery 4+++ years ago.
Neither would have been covered by Medicare at that time.
Worked out a deal a bit & paid cash-—no problems.
I know people that have too much time on their hands & too little common sense.
THEY THINK they are sick with SOMETHING-—all the time.
I just had a knee revision surgery. With PT included cost about $1200. out of pocket . hospital Billed $70k. BCBS payed out about $25k (Retired on medicare)
Two of the systems are among the best hospitals in the World & the County System is among the best trauma & burn centers in the country.
They all know the Medicaid system pays.
Medicaid is for poor people. It covers 100% of all billed services.
You’re confusing it with Medicare.
Medicare is a program for the elderly. It is still better than most private standard health insurance, even from most employers. You can get a Plus program payment free with lower out of pocket expenses that the premiums paid for a Medicare Supplement.
I’ve had a life & health Insurance license for 30 years.
I put my parents on a Medicare Plus program more than 15 years ago. My father had several health problems including suffering a mild heart attack with stent installation as well as a several day stay in the hospital for Diverticulitus in the same year. He NEVER reached his $2,000 Out of Pocket maximum expense until he developed terminal liver disease at 76. He died three years later.
My wife & I pay more than $6,400 a year for premiums for our employer sponsored HSA program that has a $7,000 deductible for a family of six.
We spend $13,500 before the Insurance pays a penny. We often exceed the out of pocket. We have six boys. They all play sports.
People in poverty have better healthcare than most working & middle-class families.
Only Real Solution:
1. Competition
2. Quantity of available physicians.
Neither insurance, pharma, med. schools, #1 and #2 want these. ✖️
Solution: Antitrust prosecution.
The ONLY way.
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