This was a pretty damned depressing article:
http://www.oregonlive.com/health/index.ssf/2012/03/health_insurance_will_cost_mor.htmlHealth insurance will cost more than the typical family earns in 2033, Oregon study predictsTuesday, March 13, 2012, 4:15 PM
By Joe Rojas-Burke, The Oregonian
Annals of Family Medicine
The federal Affordable Care Act is projected to slow health insurance cost increases, but it will buy only four more years until the costs of coverage exceeds median family income, according to an analysis published in the Annals of Family Medicine. Health insurance for a family will cost as much or more than the annual earnings of half of U.S. households by 2033, if insurance premiums and wages continue to grow at recent rates.
And while the federal Affordable Care Act is projected to slow the rate of growth, it will buy only four more years until the costs of coverage exceeds median family income, according to an analysis co-authored by Dr. Jennifer DeVoe of Oregon Health & Science University.
The researchers warn that the U.S. health care system is headed toward a meltdown unless the country can agree on reforms that substantially curb the growth of spending.
"We're not bending the cost curve enough," says DeVoe, a family medicine physician and associate professor. "It's an unsustainable system."
Health insurance costs have raced ahead of wages for many years. Annual premiums for employer-sponsored family health coverage exceeded $15,000 last year, up 9 percent from 2010, according to surveys by the Kaiser Family Foundation and Health Research & Educational Trust.
From 2000 to 2009, health insurance premiums jumped 8 percent each year on average while household incomes only rose about 2 percent a year. DeVoe and co-author Dr. Richard Young of John Peter Smith Hospital in Fort Worth, Tex., projected the growth of insurance costs and wages from 2010 to 2040 based on the observed trends from 2000 to 2009.
Their projections factored in the Congressional Budget Office's estimate that the Affordable Care Act would curb the growth of private health insurance costs to 7 percent a year. Even with that assumption, the researchers estimate that the average cost of a typical family's health insurance premium will equal half of household income by the year 2022. If out-of-pocket costs are added to the premium costs, we'll reach the 50 percent threshold before 2018.
"It rings true," says Don Antonucci, president of Regence BlueCross BlueShield of Oregon. "The system we have today is clearly broken."
Spending on health care accounted for less than 5 percent of U.S. economic output in 1950. Today, health spending accounts for more than 17 percent of gross domestic product.
New medical technologies are probably the most important driver of health care costs. Medical innovations, such as kidney dialysis and high-tech body scanners, tend to make it possible to detect and treat previously untreatable conditions, thus saving lives while adding whole new categories of spending.
Insurance coverage, meanwhile, has allowed most people to partake of the benefits of high-tech medicine unburdened by the true costs, which has boosted demand. For decades, payment incentives have generously rewarded doctors, hospitals, imaging centers and other medical providers for doing more tests and procedures, even if they aren't needed.
The Affordable Care Act includes several long-term measures intended to control spending. For instance, it calls for the formation of Accountable Care Organizations. In Oregon, these groups of doctors, hospitals and other caregivers will be responsible for coordinating all mental, physical and dental care for people covered by Medicaid, the government program for the disabled and poor. The state is designing payments to reward caregivers for keeping members healthy and achieving quality goals.
Savings are expected because poorly coordinated care results in a lot of wasted spending and missed opportunities for preventive care that could keep people out of the hospital.
Some experts assert that getting spending under control will require getting consumers to be more responsible as purchasers of medical care -- and minders of their own health. "We need a cultural shift, where people are asking about cost in addtion to quality," says Antonucci, the Regence executive. He says health reform also needs to focus on helping people make their lifestyles more healthy.
DeVoe and Young don't disagree, but writing in the Annals of Family Medicine they say that the U.S. will ultimately have to take a stand on limiting access to some services:
"The tipping point may come when patients and physicians realize that we cannot provide all possible services to all people, no matter how rare the benefit or expensive the service. The recent approval by Medicare of the prostate cancer drug sipuleucel-T (Provenge), which will cost an estimated $93,000 for treatment to increase life expectancy by 4 months, is an example of a very expensive service contributing to health care inflation."
As it stands, DeVoe says our system rations care by denying services to people who can't afford good health insurance. “Nobody wants to talk about explicit rationing, where you decide what services will be provide and what services will not," she says.
- Joe Rojas-Burke
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