What The Numbers Might Be Saying

A recent study by the Commonwealth Fund (a private foundation that researches health policy issues) shows that US health insurance deductibles doubled over the last seven years.  The deductible is the amount a policyholder must pay before most, if not all, of a policy’s benefits are available.  It is calculated annually, so the full amount must be met for each policy year.  The deductible is considered to be an out-of-pocket expense.

The Commonwealth report focused on employer-provided health insurance.  It showed that total premiums – amounts paid by employers and workers combined – for family coverage rose 50 percent from 2003 to 2010.  At the same time, the workers were taking on more of that burden.  Their portion of the annual premiums rose 63 percent over the same period.  The result?  According to the study, “many working families have seen little or no growth in wages as they have, in effect, traded off wage increases just to hold onto their health benefits.”

And that’s not all.  Employees are paying more each year for less, because of the higher  deductibles already mentioned.  The average family deductible amount essentially doubled over the same seven year period, coming in at nearly $2,000 in 2010.

On the individual health insurance side, the trend has been towards high deductible plans.  These are great if you are both really healthy and really lucky.  The monthly premiums are low – a big plus.  The theory here is that keeping the premiums low will encourage us to save up for emergencies.  How valid this is, that’s anyone’s guess.  But should something major or catastrophic occur, initial expenses will be very high.  This is because the entire deductible – often at $10,000 these days – must be met before the insurance carrier will cover many of the services we’ll need, including hospitalization.

Reuters reported on a different Commonwealth study last June, when the US ranked  dead last – again –  in a comparison of the health care of developed countries.  The other countries were Britain, Canada, the Netherlands, Germany,  Australia and New Zealand – pretty impressive company.  America spends, on average, twice as much per person for healthcare as the other nations, and yet ranks last on safety and surprisingly poorly on quality and access to primary care and after-hours care.  And of course, we do very poorly on the price of going without care because of cost.

The report factored in five measures of healthcare – quality, access to care, efficiency, equity and the ability to lead long, healthy and productive lives.  Interestingly, as much as we all criticize and belittle Britain’s national health system, that country came in first for quality.  The Netherlands ranked first overall on all scores.  Every other system covers all of its citizens, while the US leaves out more than 46 million Americans, or the 15 or more percent with no health insurance.

There was something else interesting in this report.  It observed that “the lower the performance score for equity, the lower the performance on other measures.  This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen”.  It’s a good thing, then, that previous reports by this nonprofit group, with its investigations into healthcare performance and promotion of changes in the US system, have been widely used by politicians and policymakers alike to organize reform.

There are those who think the trouble in America is more about lifestyle than our healthcare system.  We have, for example, higher rates of obesity than other developed countries.  But then again, our patients with chronic diseases and conditions are more likely to say they’ve gotten the wrong drugs or medications or have had long, long waits to learn of abnormal test results.  Other counties have higher rates of smoking, but still rank better than we do overall.  Germany’s much older population has more chronic diseases and yet that nation still beats us in terms of healthcare.  So maybe it isn’t just about lifestyle.

Here we are,  spending more, earning less, accessing lower quality and less comprehensive care that’s not delivered very efficiently and is not equitably available anyway.  What does this tell us?  There’s much at stake here, for the insured and uninsured alike.  We know this.  More to the point, then: are any of our leaders on board?


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