Actually, health insurance premiums are rising more slowly

Health care and insurance costs are, however, still rising and need work. Let’s just make sure we consider all the facts.

By Dimitri Drekonja, M.D.
Star Tribune (Minneapolis), Nov. 20, 2014

In “Gruber’s gaffes show why MNsure was sure to fail” (Nov. 20), Sen. David Hann, R-Eden Prairie, asked for “every well-intentioned voice to be heard” and urged that we “take a hard look at the facts.” Good advice, which I’ll try to follow.

Hann cites the Kaiser Family Foundation as his source that health insurance premiums are increasing by 20 percent in the last year. On the face of it, this seems noncontroversial. Kaiser is a well-respected nonpartisan organization that many rely on as a source of high-quality analysis of health policy, and an annual increase of 20 percent seems high.

However, I happened to be catching up on my journal reading last night, and a recent issue of the Journal of the American Medical Association (JAMA) had an update on health insurance costs, provided by Kaiser. For those wanting to see it, it is freely available at the JAMA website (

The report tracked increases in health insurance premiums over three five-year periods (1999-2004, 2004-2009 and 2009-2014). For the last five years, the increase in premiums agrees with Hann’s number: 26 percent. However, what Hann chose to leave out is that from 1999-2004, premiums rose 72 percent, and from 2004-2009, the increase was 34 percent.

So over the last 15 years, the lowest increases in health insurance costs came during the period in which the Affordable Care Act (ACA) began to be implemented.

This is one of the good things about the ACA — costs have not risen as fast as during the pre-ACA period. The other good thing is that more people have health insurance.

However, there are indeed problems with the ACA. An improvement from the pre-ACA days was easy — costs were rising rapidly and the number of uninsured was far too high. The downsides are that we still have millions of people uninsured and that the cost of insurance still is rising faster than both overall inflation and workers’ earnings (from 2009-2014, when premiums rose by 26 percent, overall inflation and workers earnings both rose 11 percent). This pattern is ultimately unsustainable.

Responding to Hann’s call for facts, here is another: the United States spends close to 20 percent of its gross domestic national product on health care; the next closest countries are France, Germany, Switzerland and Canada — all hovering just below 12 percent and all of which are able to provide universal health care coverage for their citizens.

If Hann is indeed interested in these facts and wanting “every idea to be considered,” here is a suggestion: Just down the road is the University of Minnesota, an institution with the resources and expertise to study different ways of providing health care for all Minnesotans. Give researchers the task of assessing the pros and cons of various ways to pay for health care. They could consider a single-payer system like Canada’s; a system that includes private insurers, like Germany’s; the current status quo with the ACA, or some proposal put forward by Hann and his colleagues (if he has such a plan, I am unaware of it).

Let each proposal undergo rigorous analysis by experts in the field, and share the results publicly.

Studying what someone (like Prof. Jonathan Gruber) said three years ago about how a piece of legislation passed is not terribly high on my priority list; studying how to achieve a cost-effective way to provide health care to all Minnesotans is.

Hopefully, this is a goal shared by Hann, and he will indeed look at all the facts.

Dimitri Drekonja is a staff physician, infectious diseases, with the Minneapolis VA Health Care System, an assistant professor of medicine at the University of Minnesota Medical School and a board member of the Minnesota chapter of Physicians for a National Health Program. The views expressed here are solely his own.