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.