In this excellent review of the late Uwe Reinhardt’s book “Priced Out,” Dr. Adam Gaffney lays out in cogent terms why we cannot understand rising health care spending in America in simple terms of either over-utilization or insurer-provider price negotiation.
This writing is especially impactful to me because I became interested in health care due to frustration with how high health care prices were keeping people in poverty from getting the care they needed, and was initially very persuaded by super-utilization arguments. I followed the work of people like Jeffrey Brenner because at the heart of it, I saw compassion for patients harmed by lack of preventive care and social services. However, I also absorbed the subtle patient-blaming aspects of this approach.
In medical school at UPenn, I got involved in excellent research by Heather Klusaritz through which I had the opportunity to interview patients who had been labelled at super-utilizers due to frequent visits to emergency departments. In these conversations, I was forced to confront my internalized bias against these patients who were described as “inappropriately” visiting emergency departments for complaints that were not true emergencies. Through these conversations, I gained a deeper understanding of the inadequacy of our health care, public health, and public welfare infrastructure. If frustration with these systems led me to medical school, it was in medical school that I saw just how bad things really were.
With faculty like Zeke Emanuel providing our health care systems lectures, I initially bought into neo-liberal arguments that these were simply failures of incentives. Part of me believed that if enough Ivy League technocrats crafted just the right policies–Rube Goldberg-esque as they might be–private insurers and for-profit hospitals would provide for the health care Americans needed. However, over time I began to see how market forces would never be sufficient to guide health care allocation and development, and it will only lead to ever-rising health care spending at the expense of everything else in our budgets.
For both the private insurers and profit-driven hospital systems, increasing health care spending is just more cash in their pockets. Your deductible is their kid’s private school tuition payment. Health care isn’t expensive in America because of utilization. Health care is expensive in America because it profits those with power. There is exactly one real policy solution to the fact that we now pay nearly $11,000 per year for health care in America compared to an average of $4,000 per year in OECD countries and that solution is single-payer Medicare For All.
High health care spending in America means lower wages for Americans. It means high deductibles, frequent medical bankruptcies, and families rationing health care because they need some money for groceries. It is inhumane and we’ve tolerated it for far too long. As long as private insurers are the payers in the American health care system, there will always be insurance trolls whose priority is to deny cancer patients their chemotherapy or to put huge paperwork burdens in front of patients and doctors to discourage necessary care. As long as private insurers are the payers, hospital systems will spend enormous amounts of money on flashy branding and sleek buildings to attract wealthy patients as if a person’s income determined the value of their life.
So read Adam Gaffney’s piece and vote only for those politicians who support Medicare For All because it is truly our only way to a better future for health care.
Toward Health 