By Dr. Howard Brody
All agree that health care in America is rapidly becoming unaffordable for too many people. So, a slowdown in health spending growth would seem to be good news.
Or is it?
A report by the Robert Wood Johnson Foundation and the Urban Institute recently looked at the slowdown, said by many to be because of the recent recession. The report noted that while economic hard times played a role, costs were already starting to go up more slowly even before the recession set in.
Other factors moderating costs were fewer Americans being covered by employer-sponsored insurance and relatively more being dependent on lower-paying Medicare and Medicaid.
If health costs go down because we’re being smarter at how we spend our money, and people who need care can still get it, then the cost cutting is good news. But if the price paid for lower costs is reduced access to beneficial care, we need to think twice about our policies.
A number of measures that might reduce costs even further are included in the health reform law, the Affordable Care Act or “ObamaCare.” The RWJ-Urban Institute report states that while promising, these programs had not yet taken hold and because of that could not get any credit for the way costs have already moderated.
Those of us who live in red states generally hear criticisms of the health reform law that come from the political right. We usually don’t hear the complaints that come from the left. But some of those complaints may carry an important lesson.
Left-leaning critics of the Affordable Care Act warn that it is about to usher in an era of serious underinsurance.
Today, and even before health reform, this was a major problem, with as many as 60 percent of personal bankruptcies in the U.S. caused by health care bills. You’d imagine that must be because of people having no insurance coverage, but the majority of the folks going bankrupt actually had health insurance.
Some critics now charge that the reform law will worsen underinsurance in two ways. More people will become eligible for Medicaid, but the expanded Medicaid programs may end up paying for less care. Affordable care organizations and insurance exchanges may offer lower-coverage plans than people today are used to getting from their employers.
If underinsurance gets worse, it’s not necessarily because the architects of health reform wanted it that way. They were between a political rock and a hard place — cover more people but keep costs low. The only way to do that is to extend bare-bones health coverage more widely.
Many people believe that there’s a lot of money being spent today in health care that really doesn’t make anyone healthier. A targeted policy that set out to eliminate those wasted dollars might reduce costs substantially while extending solid insurance coverage to more people. Sadly, neither political wing in America seems willing to focus its attention on those sorts of carefully targeted cuts. The result will be more bumps in the road on the way to a health system that properly meets the needs of the population.
Dr. Howard Brody is director of the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston.