The ACP Advocate Blog
by Bob Doherty
Tuesday, November 18, 2008
Health care reform is all about affordability
When the Kaiser Family Foundation asked voters to name the top health care issue that they wanted the candidates to discuss, affordability came out as number one in its October poll. By affordability, the voters meant how they are paying for health care and health insurance.
It shouldn't come as any surprise that voters are concerned about affordability. Victoria Knight, writing in the Wall Street Journal's blog, observes that the health insurance tab is creeping toward half of family income. Susan Block reports in USA Today that the average employee's health care costs, including premiums and out-of-pocket expenses, will increase 8.9% in 2009, far outstripping wage increases and overall inflation.
Making health care affordable to individuals and families should be a goal of health care reform. But health care also needs to be affordable to the country as a whole - that is, the nation has to be able to produce enough wealth to sustain a given level of health care spending, which is not the same thing as personal affordability.
On this score, the public is unconcerned. The same Kaiser tracking poll found that only 6% of voters identified "reducing the total amount the country spends on health care" and only 7% cited "reducing spending on government programs like Medicare/Medicaid" as issues that the candidates should address.
In my mind, reducing (or at least limiting the rate of increase) in health care spending is the central issue. One could envision reforms that on paper make health care affordable to individuals, such as by capping out-of-pockets costs or premiums, but bankrupt the country in the process. In reality, the only effective way to make health care affordable is to lower health care spending.
The problem is that controlling health care costs will require trade-offs that the public seems disinclined to consider, such as restrictions on access to tests or procedures of uncertain value.
Let's not blame the voters though. Politicians haven't been profiles in courage in explaining why the country needs to reduce health care spending, and how. Nor have stakeholders - hospitals, health plans, unions, drug companies, device manufacturers, and yes, organized medicine - been rushing to say what they're willing to give up to lower spending. (Each is pretty good though at pointing out how someone else should cut their spending.)
Today's questions: What do you think can be done to make health care affordable - not only to individuals, but the country as a whole? What should physicians be willing to give to help cut spending?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- The "It's a Wonderful Life" approach to "scoring" ...
- Who Will Guide Us Out of Health Care Turbulence?
- Senator Baucus' Answer to Who Should Pay for Prima...
- Senator Baucus' health reform proposal
- Who should pay for coverage?
- Who will pay for primary care?
- Will single payer advocates get behind Obama-style...
- What do we do now to bring about health care refor...
- The 2008 election and health care reform
- Will physicians reverse the pattern of voting at a...
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.