Health  Care,  the Many and the Few

I was reading an article by two ObamaCare cognoscenti from the Dartmouth Institute for Health Policy and Clinical Practice (Elliot Fisher and Peter Lee, “Towards Lower Costs and Better Care – Averting a Collision between Consumer- and Provider-Focused Reforms, “ NEJM, March 10, 2016).

The article advances the argument that only if  physicians and hospitals cooperated  to improve care,  and patients were more price-sensitive,  care quality would get better and outcomes would be superior.

These statistics caught my eye.

·         Accountable Care Organizations (ACOs) now cover 26 million Americans.

·         Employer-sponsored coverage plans with deductibles of over $1000 has increased from 10% to 46%, and 93% of covered workers  now must pay for doctor visits with co-insurance or co-payments.

·         High deductible plans have led to a 10% decline of  preventive services and an 18% drop in physician visits.

·         The health exchanges cover only 10 million Americans, or 4% of Americans under 65 years of age.

·          75% of health exchange enrollees can obtain primary care without being subject to a deductible.

Let's  put these statistics in a larger perspective .

Percent of  330 million Americans receiving or not receiving  coverage.

         ·         10 million in health exchanges, 3% of total, controversial  because of high costs of subsidizing ,  low number of physicians accepting exchange patients,  low level of acceptance by the young and healthy,   heavy losses by insurers,  and financial failure of  health exchange co-ops, 12 of 23 of which have gone bankrupt. 

• 70 million in Medicaid, 21% of total, which is growing at an unprecedented high  rate under ObamaCare,  partly because of high rates of signups during health exchange campaign, which imposes cost burdens on states.

•   55 million in Medicare, 17% of total, which is growing at rate of 10,000 a day, or roughly 3.65 million a year.  Contentious because Medicare contributes heavily to national  budget deficit of $19 trillion and because ObamaCare  cuts Medicare by % 565 billion and redistributes money from middle class to underinsured and uninsured.

•    160 million in employer-sponsored plans,  48% of total,   which has come under fire because of relentless rises in premiums and deductibles,  transfers to costs (i.e,  “cost sharing”) to consumers through health savings accounts,  regulations and penalties for employers with more than 50 full-time workers.

• 33 million uninsured, 10% of total,  who are the object of most liberal critics,  who say health coverage is a right and lack of  coverage  is  at once  a scourge, shame, and abomination and which could ended by compassionate universal government-sponsored care  or Medicare-for-All by a mere $15 trillion or so.   The chief aim of ObamaCare,  projected to cost $1 trillion over the next decade,  is to limit the number of uninsured and those living below federal poverty levels.

• 12 million illegal immigrants, 3.6% of the total,   a few  of whom receive limited benefits but most of whom live “in the shadows”, and who are ineligible to receive benefits.

To paraphrase Winston Churchill, " Never in the field of human health affairs has so much been owed by so many of the insured  middle class to so few  un-insured and under-insured.