Op-Ed

Health costs real problem

Protesters greeted Vice President Mike Pence when he was in Lexington earlier this month to push for repeal of the Affordable Care Act.
Protesters greeted Vice President Mike Pence when he was in Lexington earlier this month to push for repeal of the Affordable Care Act.

Americans will always be at loggerheads about health-care reform until we stop acting like the blind men trying to describe an elephant by touching only one part of the animal.

Look at the whole elephant and you’ll see the cost of health insurance is the tail end of a much bigger problem.

Republicans promised to cut premiums for many by reducing the number insured and what has to be covered, which doesn’t address the real problem: the cancerous growth in health-care costs.

That’s because insurance premiums are largely driven by three factors: the number and health of people covered, what’s covered and, most important by far, the cost of delivering health care.

Do the math.

The United States spent $3.2 trillion on health care — 17.8 percent of gross domestic product — in 2015, according to the Centers on Medicare and Medicaid Services. That’s more than any other nation, according to The World Bank, for worse outcomes on life expectancy, infant mortality and other measures, a 2014 Commonwealth Fund study found.

Our annual cost is projected to grow 5.8 percent a year, or 1.2 percent faster than GDP growth through 2025, according to the CMMS.

Say what you will about the 2010 Affordable Care Act (or Obamacare), the CMSS statistics show the growth in health-care spending as a percent of GDP slowed dramatically since it was passed. (How much the ACA deserves credit is debatable, but it helped.)

Reducing the number of people covered, or the quality of their insurance, doesn’t slow that growth. It merely shifts the burden.

Blame President Ronald Reagan. In 1986 he signed the Emergency Medical Treatment & Labor Act ensuring access to emergency services regardless of ability to pay.

The federal government reimburses hospitals for some charity care costs. But they either absorb much of it or pass it on via higher charges to patients and insurance companies, which means higher premiums.

In Kentucky alone, the Affordable Care Act cut uncompensated care between 2012 and 2015 by 76.9 percent, from nearly $2.4 billion to $552 million, according to a 2016 report by the Foundation for a Healthy Kentucky.

So while the growth in some people’s premiums may slow down at first under Republican plans, millions who lose insurance and Medicaid coverage (voluntarily or not) will flood emergency rooms. Typically, they are sicker and more expensive to treat because they’ve had no preventative care. It’s like trying to save money by not replacing the oil and spark plugs in your car — sooner or later you’re going to pay a ruinous bill.

Many Republicans argue the marketplace, freed from government interference, will drive down costs. That didn’t work before Obamacare and it won’t work now because there’s no transparency in medical costs, no market constraints on drug prices and rarely time for a consumer to research prices.

So, we need to stop looking at the wrong end of the elephant. Otherwise, the pachyderm will morph into a lion that will maul one-sixth of our economy.

John Winn Miller is a former journalist who now produces independent movies.

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