The Commonwealth Fund (a proponent of Big Government health care) released its 2023 health care survey that found about half of Americans have problems affording health care.
Given the necessity of insurance to defray the full cost of health care in the United States, it shouldn’t come as a surprise that the vast majority of people who had spent some time uninsured during the year would report difficulty affording their health care costs. More surprising is the large share of adults who had insurance all year but still report difficulty paying health care expenses. Forty-three percent of people in employer plans, 57 percent enrolled in marketplace or individual-market plans, 45 percent with Medicaid, and 51 percent with Medicare said it was difficult to afford their health care.
Commonwealth asked people if they have skipped needed care or skipped prescribed drugs due to the cost. As an aside, that’s the type of question Commonwealth and other public health advocates have surveyed for years and it’s not really a good indicator. There are numerous reason people skip care, including inertia, inconvenience, cost, unknowns (about the former), indifference, lack of concern and reservations about the benefits of medical care. I suspect cost is a catch-all for other things, including perceived value.
Despite my reservations about whether Commonwealth is surveying what it thinks it’s surveying, the results are interesting, nonetheless. About 38% of those responding to the question said they had delayed care or skipped drugs due to cost. Only 29% of those with employer coverage had delayed care, whereas 37% of those with Obamacare had delayed care. Oddly enough, 39% of those with Medicaid and 42% of those on Medicare reported they had delayed care due to cost. Medicaid has little cost-sharing. Stop and think about this paragraph for a second: those with government coverage (Medicare, Medicaid and Obamacare) were more prone to report delaying care due to cost than those with employer coverage.
More than half of people who skipped care reported their health got worse as a result. I wonder if those who did not skip care were asked if their health got better or worse. I wouldn’t be surprised if many who did not skip care reported the care did not have the desired effect. That also plays into why some people skip care due to the cost. Sometimes, it’s not the cost per se, it’s the cost/benefit ratio that doesn’t meet the threshold of value.
The organization went on to report that about one-third (32%) of respondents reported medical or dental debt they were paying off, while 36% said that debt caused them or a family member to delay or forgo care. Half (51%) had medical debt of less than $2,000, while less than one-fourth (22%) had medical debt of more than $5,000.
In the grand scheme of things medical debt is not bad if it is for needed care. The problem is not the debt, it’s the inflated prices that sometimes lead to debt. I often tell the story of my wife almost getting a CT scan at a hospital outpatient clinic where it was about seven times more expensive than a free-standing radiology clinic. Until I told her she had no idea hospitals are far more expensive than any other provider. If you went into debt for potentially lifesaving care, that is a bargain. I repeat, it’s not the debt that’s bad. It’s the prices that are bad. According to the survey, hospital care is the source of debt in just over half of those reporting. Hospitals charge the highest prices of any place that provides medical services.
Many respondents said that their health care costs made it harder for them to afford other living expenses. While people without insurance for all or part of the year struggled the most, even people with coverage all year reported problems affording other things. Among those with any type of private insurance (employer, marketplace, or individual-market), 30 percent or more said their health care costs had made it harder for them to pay bills like those for electricity, heating, food, or credit cards. People with Medicaid or Medicare reported similar problems: two of five said their health costs had made it harder to pay food and other household bills.
Not really discussed in the report is that people skip care mostly because prices are too high and too much of health care is a poor value compared to other used for their money. Medical prices are not transparent and patients were never taught to act like health care consumers. It is often assumed people are too ignorant to shop for care. It’s not that people lack intelligence, it’s that providers are not competing on price and often go out of their way to hide prices. This must change. Health care is the only area of our economy where a blanket form signed at the check-in desk is considered mutual assent (a meeting of the minds), adequate for an enforceable contract. It’s not. Barak Richman, a Duke University law professor, has argued that mutual assent could be used to fight surprise medical bills. It should also be used to fight pricing that is not transparent or explained.
Read more at Commonwealth Fund.
Correct Devon, The Commomwealth Fund is for Socialized Medicine. Why do you spend time with Socialists and NEVER ever discuss free market alternatives? Teachers in Indianapolis (Carmel ISD) are paying $875 a month out of their paychecks but if they get too sick to work their COBRA is $3445 per month. In CONTRAST, Trump’s STM is $229 for a 30-year-old couple and child. That is less than 1/10th the price of Government healthcare. You’re an ECON man!
My question is; Why are these teachers paying dues and then pay 4 times more than the Private Sector? Do teachers have ultra-low IQs to pay 4 times more PLUS pay dues?
It takes AMAZING propaganda to get citizens to pay $3,445 month to Blue Cross when NOBODY else in the WORLD would charge that much and BLOGS like this, dedicated to the ECONOMICS of healthcare, NEVER say a word about premiums but only discus the deductible, like this story.
Employees think about deductibles and not premium. Medicaid in Indiana was 4 times the price of the Private Sector too. Why do all think tank people NEVER talk about FREE Markets? I suspect that this blog is getting kickbacks from Blue Cross to distract from reality. I bet it’s hard to look in the mirror and shave for these blog writers. All we know for sure is that Obamacare and Medicaid people are not treated at MD Anderson Cancer Hospital but Trump’s low-cost family coverage for $229 in Indianapolis does have MD Anderson in Houston as a Member Hospital. So there are a lot of unnecessary dead young women and children Devon. Feel any responsibility?
Devon, trust me, the Private Market is cheaper with the BEST products! less than 1/10th the price! You’re kickbacks for distraction can’t be that much to empower this scam. Think how much better you would feel if you helped mankind. Your self-image would have to improve.
Blue Cross Association = Crony Capitalism. Speaker Mike Johnson’s lousiana has what percentage Market Share for Blue Cross? Is it a MONOPOLY? Is Blue Cross paying kickbacks to politicians? Centene is, the largest in Obamacare and Medicaid. Florida Blue pays more money Florida politicians than any other entity. Devon won’t discuss Blue Cross. Devon likes to discuss Singapore, were all MSA market testing was done prior to the MMA and HSAs. (Sure, sure)
If the cost of hospital care were not a hardship to a large percentage of people, the hospitals would simply raise prices until they were. Much like colleges will raise tuitions in order to absorb all available loan financing.
I wonder what would be the dynamic if you separated coverage into two layers, to be purchased separately. A price-negotiation layer similar to GoodRx, only for inpatient and outpatient care, and an insurance layer that treats negotiated prices as “in network.” The pricing layer doesn’t need to underwrite as it’s under no risk due to members’ health status. And the insurance layer has access to all the prices negotiated by its accepted purchasing networks, so it only needs to deal with patient risk.
I suppose there is danger of kickbacks between the layers corrupting the system unless prohibited. And insurers may be reluctant to accept pricing from an independent purchasing network. Unless the purchasing networks are captive, but are required to be open for public membership.
Bart, the concept you outline is similar to the way I understand the French do it. I have thought for at least 20 years that theirs is a superior system to most others in the world. Much of what I recall about the French system comes from our two daughters who both lived and worked in France during the 2000s. I had agreed to cover the cost of their individual coverage before they moved. Unlike their mom, dad was relieved when the girls both took employment in France.
The French government provides the first layer for everyone, paid by taxes. The coverage approximates (or did at one time approximate) 80%-85% of the overall projected cost Individuals are then free to choose whether to buy the second layer from a private insurance company of their choice. Almost all do choose this second layer and pay premiums directly, because the first layer – like US Medicare – provides much less coverage for non-hospital expenses.
That arrangement leaves the insurance companies with two sorts of risk, a selection risk (which as I understand your concept is what you call patient risk) and a utilization risk which is not identical to the selection risk (because it includes the cost of new services, new medications, new techniques, and new technologies that come on the market, unrelated to any patient conditions)
Thanks, John for the response. But I was thinking more in terms of completely separating the pricing layer from the insurance layer, and not simply having two tiers of insurance. Which you could still do, of course, within the insurance layer.
The idea would be to provide price transparency and to keep pricing ability from biasing insurance purchasing choices. I don’t suppose the large insurers would like the idea much.
Thanks to Devon for a very intelligent article.
He is right to point out that the survey seems kind of sloppy in some areas. No one on Medicaid skips health care due to cost; if a survey subject said that, they should have been interviewed again to get the real reasons involved.
I think there will always be some skipping of health care. My own sons refused for several years to get braces, due to vanity…not because it would cost them anything. I skipped annual physicals several times,, and not due to costs. I suspect that skipping medical care has a male/female bias, men being more likely to skip so that they can feel tougher.
I am not sure that I have a blanket answer to the whole phenomenon. We don’t want people pulling out their own teeth because they can’t afford a dentist…..but we don’t want people skipping needed heart care, because price controls have driven away providers. We have to keep an open mind and look for “the greatest good for the greatest number.”
Bob, wake up. In the real world, teachers are paying $875 per month out of their check as their employee share for Blue Cross. This is 4 times the cost of Trump’s Plan, which is HSA qualifying, in the FREE and open market. They still have deductibles Bob, Your son’s refusing braces is just more of your group salesman BS that means NOTHING.
Just listen to Dr. Goodman, ha ha. A year ago Goodman with Pete Sessions videotaped a ZOOM call with the Heartland and [Goodman] says that Direct Primary Care (DPC) cost is $50 a month for a Mother and child! OUCH! In REALITY; The State of Nebraska offers DPC for $724/month for Mom and child. To add a husband and Direct Primary Care (DPC) is $1,212 per month per family. So Goodman saying $50 when in reality it is OVER 10 TIMES more! ha ha Don’t forget the Nebraska State employee is paying $3,016 per month for health insurance. Combined Health insurance and Goodman’s DPC and the total cost is $3,016 + $1,212 = $4,228 per month or $50,736 per family!!
See how insane Goodman, Devon, and the bloggers are here? Bunch of Bozos.
John wants to compare the French system to the USA. I was in France to get the award for enrolling the 1st tax-free MSA in October of 1996. The formal award was in the Old Paris Opra but we stayed at the Le Grande across the street. I asked the French bartender how he pays for his insurance and he said, “I don’t know, they just take it out of my check.” I told him, “You sound like an American.” We witnessed multiple French hospitals and they were about the size of a 7-Eleven. Don’t think they have great big huge buildings that take up square blocks like in the United States. These are itty-bitty places so most people do everything at their itty-bitty [pharmacias], pitiful country. Even in Nice in the South of France, the hospital was about 4,000 square feet and on the 2nd floor. Those poor billionaires fly to America for surgery.
Bart just makes no sense at all. Also, Goodman wants Pete Sessions to TAX the tax-free HSA!
[I’m saying Goodman is evil]. He thinks Medicare Advantage (MA) is the way to reform Obamacare. Personally, I think Goodman is so out of touch it is like Biden. Goodman did his famous [add the deductible and premiums together] and said that is the cost and then said $11,000! That is so old the Obamacare deductible alone for 2024 is $9,450 per person. Sessions is an idiot that should not make law. Goodman is saying Andy Rooney and Golden Rule wrote the 1st MSA!!
Imagine how I feel when after 27 years Goodman is still lying. It isn’t even polite. Devon does it too as he cashes his NON-PROFIT’s checks. Checks for LIES! And it isn’t an interesting article.