House progressives are determined to establish a comprehensive government takeover of health care through legislation such as Senator Bernie Sanders’ (D-VT) “Medicare for All” legislation which would create a single-payer government health system.
Single-payer advocates often claim that single payer healthcare would significantly cut spending on healthcare; however, such claims are false.
Health Care Costs
Health-care sector is the cornerstone of American economy, employing 11 percent of employees and accounting for 24% of government spending (Centers for Medicare & Medicaid Services [CMS], 2019). Consumer spending on health-care was estimated to comprise 8.1% of total household consumer expenditures in 2018, the highest share among all spending categories.
American residents spend over twice as much per capita on health care compared to comparable nations, yet still trail many in terms of access and some key outcomes. Why does this occur? Several reasons could account for such high health-care costs: including having one of the world’s most complex and costly systems of delivery as well as spending that does not directly improve health outcomes.
Health-care prices have seen significant inflation-driven inflation over the last two decades, as their cost increases far outstripped other goods and services. While inflation and medical innovations could contribute to this phenomenon, most of it can be linked to rising drug costs, hospital services costs, diagnostic tests costs, physician compensation increases that outpaced inflation by twofold or more – an effect which has had more of an impact than expected on medical inflation rates.
Health-care prices across the nation can be highly variable. A functioning market should protect its consumers by eliminating businesses that charge drastically different prices for similar services; health-care markets defy this expectation; for instance, blood tests in Baltimore might cost $22, while in El Paso they might go as high as $37!
Policymakers must consider several measures to help limit these unsustainable and harmful price fluctuations. They could increase competition between hospitals, such as by mandating public disclosure of prices and negotiations of discounts with physicians; increase competition in health-care services via competitive bidding; or experiment with using Medicare, Medicaid and private health-insurance funds for services that promote improved outcomes such as food insecurity management or transportation needs for medical appointments.
Access to Care
Many Americans experience difficulty accessing health care. According to one quarter of adult respondents, one out of every four have skipped doses or not filled a prescription due to cost, with larger shares among Black and Hispanic adults, women, households living on lower incomes, and those who live alone reporting this issue. Given its massive role as one of the major employers and spenders in society today, health-care services availability is one of the key measures of quality of life in America.
Health-care availability varies significantly across geographic regions. Rural residents tend to have less insurance coverage than their urban counterparts and greater barriers when accessing care – for instance telehealth offers remote patients another avenue of communication between doctor and patient via phone call or video conference; but rural individuals often lack broadband internet connectivity which prevents them from taking advantage of this option.
Health-care costs disproportionately impact those without private or public insurance coverage. In 2006, more than four out of ten uninsured Americans reported postponing medical care due to cost (Harris Interactive Poll 2006a), more than double what it was among those covered under private or public plans.
Uninsured Americans were more likely than those with insurance to report discontent with their overall healthcare experience in 2003; one-third of uninsured versus 11 percent reported they were dissatisfied with the quality of personal health care provided by providers.
Though most Americans maintain positive views about their personal health, many remain very worried about rising health care prices. In 2006, respondents listed as their top concern their inability to afford needed health-care services in the future; this was higher than worries related to food or energy prices or even war and terrorism combined.
Insurance Coverage
Health insurance policies impact Americans’ spending on healthcare and determine who has access to services. Most Americans receive their health coverage either through private companies or government-funded programs such as Medicaid for low-income families and Medicare for seniors and disabled.
As health care costs escalate, more Americans struggle to afford coverage. About one-third of adults report they worry they won’t be able to meet their premium payments; 44% anticipate difficulty covering their deductible before their healthcare benefits kick in; these concerns are most prominent for Black and Hispanic adults, women parents living in low-income households and individuals without health coverage.
As well as worrying about rising healthcare costs, American citizens are concerned with the quality of medical care they are receiving. Studies have indicated that overall health outcomes in the US tend to be worse compared with high-income countries due to factors like unequal access and subpar medical schools.
Some Americans are advocating reforms to enhance the quality of medical care, including mandating more open communication from physicians about costs and procedures; providing financial incentives for patients to select more cost-efficient providers; encouraging preventive medicine as opposed to reactive treatments; as well as limiting malpractice lawsuits and implementing consumer-driven pricing on certain medical services.
The COVID-19 pandemic has demonstrated the necessity of policies which promote healthy lifestyles and protect against infectious diseases. Public health officials have developed policies, such as providing safe food or creating smoke-free areas, that aim to decrease incidence rates. Furthermore, some policies address specific risks in populations like tobacco use or unsafe swimming pools.
A third of Americans lack health insurance. Most are low-income individuals unable to afford private company rates or meet eligibility requirements for publicly funded insurance programs such as Medicaid or Medicare; some choose forgoing healthcare coverage altogether as multiple studies demonstrate increased mortality risk among uninsured populations.
Doctors and Hospitals
On average, Americans tend to be satisfied with their interactions with physicians and other health care professionals on an everyday basis. This is especially true for the healthiest state in the US. Most rate the quality of care as excellent or good while one third rated it fair or poor.
But the public remains deeply concerned by their costs associated with health care services and medicines, with most citing unreasonable hospital charges (Harris Interactive Poll 2006c).
Contrary to experts’ worries about aggregate societal or government spending, the public tends to worry more directly about paying their health care expenses directly (insurance premiums, copays and deductibles, out-of-pocket costs for medicine and services). This concern is especially strong among low-income Americans: according to one national survey conducted last year, two-thirds of those living below poverty line expressed extreme worry over funding healthcare needs.
Hospital-physician relationships were once marked by an amicable and trustful arrangement based on mutual respect, shared responsibility for patient care and strong reimbursements; this collaboration fueled by reimbursements helped deliver quality health care to the public. Unfortunately, recent changes in healthcare economics have fractured these ties as physicians and hospitals vie for an ever smaller slice of economic pie for patient care delivery.
Technology’s growing role in clinical settings has caused strain between hospitals and physician communities, especially with respect to electronic medical records (EMRs). Many hospital executives and some doctors view EMRs as creating additional administrative burdens while potentially jeopardizing clinical decision making integrity; as a result, more physician organizations have emerged to represent and support practicing physicians.
One factor contributing to rising health-care costs is competition in most markets. A few large hospital systems dominate most markets and can dictate service terms for the entire market – this is particularly evident among physician-owned hospitals that often have strong financial incentives to protect their market share even at the expense of patients.
Labor costs account for an enormous portion of health-care expenditures, especially the wages paid to physicians and other nonphysican staff. One study estimated that labor compensation accounted for 49.8 percent of health-care spending in 2012; an increase in supply could significantly lower employee costs (Eisen and Lohman 2013).