The A priori of health care-why ALL health care is unaffordable

The following is from a recent article in Health Affairs.


The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.

While I do not make light of the problems many people face who do not have health insurance, nor do I deny the need for expanded coverage, I find the basic assumption that virtually nobody can afford even modest health care intriguing. Look at the above abstract, could it be that half of the people in the group did not need to see a doctor or that they chose not to see a doctor or dentist for reason unrelated to their coverage status? Could it be that children received more care because much of the care was free or that children naturally use services more than twenty somethings?

I have written on this concept many times before, but I still find it fascinating and one of the reasons we may never truly solve the health care problem even if we evolve to a single payer system.

I am convinced the average person does not see any health care expense as something they should be responsible to pay. Consider all the goods and services a person buys in a year beyond the very necessities of food, clothing and shelter and then tell me where paying for a doctors office visit lies in the list of priorities. 

The fact is when we decide what we cannot afford, health care is near the top of any list ahead of real necessities like going out to eat, a trip to Disney for the family or even a weekly trip to the nail salon (think “The Pill” unaffordable co-pay).

Of course I am not talking about catastrophic level expenses for which we all need insurance, but that is a long way from buying supplemental coverage to pay our 20% coinsurance or mandating an array of services to be “free”. Heck, seniors routinely buy Medi-gap coverage to pay for things they paid for themselves before they had Medicare without any cost-benefit rationale.

Does anyone seriously think that those now free services are not actually affordable to most people if they chose to spend their discretionary dollars that way? Rather, we need to make them free because we know people will always choose to spend their money otherwise even when it is in their best interest to receive the health care.

Think how different and more affordable health care would be if the only coverage available was for hospitalization, medical and surgical care inpatient and fixed dollar benefits for laboratory, x-rays and the like … exactly the way it was when I started working in the health benefits field in 1961.


Categories: Healthcare

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