Affordable Health Care and Beyond for ALL Americans


In the United States, obtaining affordable health care is simply out of reach for many Americans and therefore they must do without. Businesses, states, and the federal government are cutting back on benefits because the cost of health care is simply too expensive to continue funding.  Affordable health care can only be obtained by one of two mechanisms; namely,

by decreasing the TOTAL cost of sick care and/or by INCREASING patient wellness so that fewer medical services are needed! Any action that doesn’t result in at least one of these will NOT increase affordability.

Providing affordable health care is our most pressing health care reform issue and requires immediate action. Members of America’s HICUP (BB Brigade acronym for those who are engaged in the “business of health care” in the USA) are unwilling to take the appropriate actions needed to bring down bloated costs and true health care reform is fought every step of the way. They pay lip service to “slowing the future growth” of health care spending while protecting the bloat and inefficiencies that strangle our present system. If you look at the health spending per capita (per capita means per person) for the USA and other developed nations (OECD) since 1970, it is clear that excessive costs have been a problem for a very long time.

affordable health care Spending-Over-Time

Up to 2013 (the last full year of data), you can see that USA health care costs have grown to a level that are more than double those found in other developed countries while delivering less quality. These “excess” health care costs, created over many years without reform, need to be eliminated for affordability to be achieved in the USA. Unfortunately, because of heavy influence (lobbying) by private members of HICUP (BB Brigade acronym for those who are engaged in the “business of health care” in the USA), Obamacare (PPACA) does not address reducing the accumulated “excess” from the past and only makes token stabs at future “excess”.

Members of HICUP (BB Brigade acronym for those who are engaged in the “business of health care” in the USA) increase affordability by creating health insurance products that are designed to hold down health insurance premiums costs–one component of the total health care costs.  They accomplish this by increasing patient cost share (deductibles, co-pays, maximum yearly out-of-pocket limits), reducing benefits, and limiting medical provider networks.

More “affordable” to members of HICUP = less “affordable” to individual Americans!

For example, the maximum out-of-pocket cost limit for any individual Health Insurance Exchange (also called Marketplace) plan for 2015 can be no more than $6,600 for an individual plan and $13,200 for a family plan.  To make matters worse, this limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits. For Americans with employer-subsidized health insurance, the new High Deductible Health Plan (HDHP) has similar out-of-pocket costs ($6450 single/$12900 family). Reform, HICUP-style, therefore, redistributes the cost of health care to the individual American when they are sick and most vulnerable while keeping bloat and inefficiencies within our health care system intact. These new insurance products are cheaper only if you don’t use them!  Health insurance is looking less and less like a product that shares the risk of getting sick and more like one that dumps health care costs on the sick.

affordable health care spending today and in the future
The second way to increase affordability (increasing patient wellness so that fewer health care services are required) demands a major educational undertaking with national attention and dollars. This educational undertaking must be geared at both increasing “patient engagement” in health care and defining best practices in healthcare businesses to achieve better health care value. Because our government largely spends money after sickness occurs, earmarking a greater percentage of total health care dollars to improving health before sickness would require a major shift in healthcare policy in the USA. Little to no money is spent on national wellness programs that are measured and evaluated for effectiveness. In addition, many government actions today work against keeping people healthy. For example, subsidies to the sugar industry (and not to the fruit and vegetable industries) make processed foods high in sugar relatively cheaper and encourage poor eating habits in the population.

Piecemeal measures to decrease individual program costs (government) and improve corporate profits (for all other members of HICUP) are not reaching the individual American’s pocketbook and therefore do not improve health care affordability. I measure affordability at MY pocketbook, not in HICUP (BB Brigade acronym for those who are engaged in the “business of health care” in the USA)  coffers.

To summarize:

  • Affordable health care should not only be measured by the future growth of health insurance premiums, but rather by the reduction in total cost of health care. There is no reason we should be paying double the health care costs of other developed nations.
  • The rampant waste, inefficient practices, and even corruption in our health care system need to be addressed before any cuts in health care benefits are put forward. Improving affordability does not equate to decreasing health care benefits to individual Americans!
  • Affordable health care cannot be achieved without a major shift in health care policy that recognizes (and funds) “patient engagement” and medical provider education to achieve better health care value.

Health Care

What exactly is health care? In the dictionary, health care is defined as

“the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions”.

This definition does not take into account cost, but we all know that health care that is unaffordable is NO health care in the United States.  Very few Americans are rich enough to pay for health care without taxpayer and/or employer-subsidies, primarily in the form of health insurance.  With limited healthcare dollars available, Americans must accept that every healthcare service provided by the healthcare industry will not be reimbursed by government programs and employer-sponsored insurance plans.

Providing affordable health care is an individual, employer, and taxpayer issue. A very expensive treatment that is of minimal benefit is simply not cost-effective. Taxpayer-subsidized health care programs include Medicare, Medicaid (and CHIP), Veterans Health, Tri-Care, Indian Health, and employer-sponsored and Health Insurance Marketplace plans (and more).

Taxpayer-subsidized health care must be well defined with a set of “essential” services and treatments that all Americans are guaranteed. These health care services must create measurable quality improvements (i.e., deliver “health care value”). In the USA, the true cost of health care is hidden from the individual American through subsidies and third party payers. We have been conditioned to demand any and all services “offered by the medical and allied health profession”–even if the benefit from any given service is minimal.

My definition of health care would include a component that does not require the exchange of money (through the services of health professionals); namely, the practice of healthy lifestyle choices. This is the before sickness component discussed above. Practicing healthy living habits is where health care should begin.

“and Beyond”?

This phrase is more than a warm reminder from the 1980’s movie, Toy Story. I have placed “and beyond” in the message because reforming our present flawed healthcare system will require more than chipping away inefficiencies, over-treatments, and systemic corruptions. An element of thinking outside-the-box will probably be needed and maybe even some vigorous “shaking up”. Obamacare brought universal health insurance coverage closer to reality, but did little for “affordability”.

New legislation–“Beyond Obamacare” –will have to be generated. In “Beyond Obamacare Private” (BOP) I will be addressing reform in the private sector of health care and in “Beyond Obamacare Government” (BOG) I will be addressing it in the governmental sector of health care.

“And beyond” ideas may require the creation of new private/governmental organizations and reorganizations of existing ones. The goal of “and beyond” is to improve, not grow layers of bureaucracy. These ideas need a “Manhattan Project”  mindset and not a bureaucratic business-as-usual one. One big area where “and beyond” ideas will develop is in the use of electronic data to bring about improved medical outcomes (quality of health care).

for ALL Americans

All Americans are in the same boat–we could be healthy one day and sick the next. Leading healthy lifestyles does not guarantee wellness. Some people are unlucky to be born with medical problems that require life-long health care spending. I believe that health care is a basic right, not something you need to “earn” or “qualify” to receive. If you are lucky to grow old, you will likely incur some major medical expenses sooner or later. When you need it, medical care can be a survival necessity– like food and a roof over your head. No American, rich or poor, should find themselves in a situation where increased sickness or even death occurs from malnutrition, exposure, or untreated, curable diseases because cost was prohibitive.

Many of us are fortunate to have health insurance that is employer-subsidized, government-subsidized, or a combination of both. For many Americans, the lack of health insurance coverage limits access to affordable health care. Through the Health Insurance Marketplace (also called the Exchange) and expansion of Medicaid coverage, the uninsured rate has decrease to 9.2% of the population as of mid 2015.  It needs to get to 0%!

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