A future for affordable health care

The Cost Curve Is Bending, but Not for All of Us

By Don McCanne, M.D.
Physicians for a National Health Program, March 21, 2013

Under President Barack Obama, the nation once again undertook the effort to reform health care so that everyone would have access to essential health care services. But this time it was different. The costs of health care had become unbearable to individuals, to employers, and to the government. It became an imperative to bend the cost curve of health care – to slow the growth in health care costs to a sustainable level.

Although the effort resulted in the enactment of the Patient Protection and Affordable Care Act (Obamacare), the effort falls far short. Not only will 30 million people remain uninsured, underinsurance in the form of low actuarial value health plans will become the new standard. Although the legislation included many features designed to control health care costs, most are only tweaks and unfortunately will have very little impact when considering the enormity of the problem.



By Don McCanne, M.D.

It seems ridiculous that we need a reminder that the whole health care reform movement began because health care costs were too high, but apparently we do.

Even the name of the Patient Protection and Affordable Care Act was shortened to the Affordable Care Act. Well, health care costs have continued to increase at rates in excess of inflation. Although there was some slowing, partially related to the Great Recession, affordability didn’t happen.

Current reform proposals are based on the worst possible method of controlling health care spending: shift costs directly to patients, many of whom cannot afford to pay for the health care that they need. Erecting financial barriers to necessary care might slow spending increases, but it does so by creating physical suffering and financial hardship. We need a different, more humane approach to address the problem of affordability.

Today’s article was written over four years ago, but the message is even more timely now. Every authority recognizes that we need to bend the cost curve, but it seems that too many are ignoring the “Patient Protection” part of the promise of reform. Today’s article explains how we can bend the cost curve through a system that actually improves the efficiency of our health care system so that all of us can receive the care that we need.

It is likely that the transition to a single payer system would not reduce our spending much initially. A large portion of the savings from administrative efficiencies and other beneficial features of a single payer system (see article at link above) would be used to expand coverage to everyone and to eliminate the scourge of under-insurance. The real promise is the slowing of cost escalation in the future (see the curves of U.S. and Canadian costs in the same article).

If we had enacted single payer when we first began to talk about it a couple decades ago, spending now would be much, much lower than it is. Additional delay will only further compound the affordability problem. While the subject of reform is hot, and now that the nation better understands the concept of Medicare for All, it is time to strike. Don’t let this moment cool off.

Share this article with others who care and might be motivated to do something about it. Remember, the hope of affordability rests with the future - a future under Medicare for All.