Why the health insurance system matters to everyone
Most of us have decent health insurance — we get care when we need it, and can afford the out-of-pocket costs (deductibles, co-pays, and uncovered services). We like most of our doctors. We worry about giving up what we have, since we’re uncertain what might replace it.
Yet our health system has problems that affect everyone, even those with good insurance:
Good coverage today doesn’t guarantee good coverage in a year or two. Your job may offer different insurance, or you may change to another company, or get laid off. What will happen then? Will you be insured at all, and how well? Will you keep your doctor?
Costs are out of control. Medical costs keep rising faster than wages. More and more of a worker’s paycheck goes to premiums and out-of-pocket costs. Our health insurance system has no good way to control costs.
Choice of doctors is limited. Many plans rely on narrow provider networks, so we have few doctors to select from. If we go out of network for the doctor we really want, we pay.
Hospitals and physicians have financial troubles due to the large number of uninsured patients. This leads to closures — which reduces access to care.
Delayed care for communicable disease increases infection transmission. Skipped care is due to uninsurance and underinsurance. Late diagnosis and treatment increases disease spread. This happened with COVID-19.
How big are these problems? Show me the numbers!
Health insurance changes for 25% of us each year*. Up to 60% of pregnant women change insurance during pregnancy. Common causes include a new work situation and shifting eligibility for public programs like Medicaid and subsidized plans in the Affordable Care Act. These insurance changes are linked to interruptions in physician care and medications, and worsened quality of care and health status.
Health care costs are growing at 5% per year. Wages are growing at 1.7% per year (up from 0% prior to 2012). That means over 10 years health care costs will increase by 60% and wages by 18% — creating an even larger healthcare cost burden than today.
I’d like to provide numbers about physician choice in health plans. But we don’t have the data, and that’s a huge problem, because restricted networks with limited provider options is common. Insurers should have to report these data.
Hospital closures are worrisome in rural areas, where the next nearest hospital may be a long drive away. In 2019, a record-setting 19 rural hospitals closed. Struggling hospitals are concentrated in the Midwest and South. Emergency departments also have financing problems; when a closure happens, mortality increases. Even if the ED stays open, underfinancing may slow down care. With COVID-19, hospitals have been even more stressed, especially in urban areas, and fully 97% of doctor’s offices have experienced financial problems — reduced work hours and salaries, and staff layoffs.
How did Trump’s first term affect this?
The Trump administration has focused on deregulating health insurance and dismantling the Affordable Care Act, not on addressing the problems listed above. Coverage is dropping and is less comprehensive. There have been no cost control efforts except a very recent executive order on drug prices; experts wonder how well it will work. No policies have addressed doctor choice or systematically helped struggling hospitals. Access to care for COVID-19 care has been inconsistent (see blog on under-insurance).
What does Biden propose?
Biden proposes increasing insurance coverage through a “public option” that will provide free doctor choice and low out-of-pocket costs, expanding Medicare down to age 60, and larger premium subsidies and lower deductibles for low income individuals in Affordable Care Act exchanges. To control costs, he plans to require price transparency for medical services and price negotiations with drug companies.
Does the choice of President matter?
These health system problems — that may affect any of us — will not be systematically addressed in a second Trump term. A Biden presidency is likely to partially reduce, but not resolve, them.
I hope this information helps you decide your vote.
Please share it with others.
*: For insurance geeks, the annual turnover is called the “churn rate”.
