Friday, November 15, 2013

Fwd: qotd: The United States is worse in access, affordability and insurance complexity

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-------- Original Message --------
Subject: qotd: The United States is worse in access, affordability and
insurance complexity
Date: Fri, 15 Nov 2013 04:49:47 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

Health Affairs
December 2013 (online November 13, 2013)
Access, Affordability, And Insurance Complexity Are Often Worse In The
United States Compared To Ten Other Countries
By Cathy Schoen, Robin Osborn, David Squires, and Michelle M. Doty

The United States is in the midst of the most sweeping health insurance
expansions and market reforms since the enactment of Medicare and
Medicaid in 1965. Our 2013 survey of the general population in eleven
countries — Australia, Canada, France, Germany, the Netherlands, New
Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United
States — found that US adults were significantly more likely than their
counterparts in other countries to forgo care because of cost, to have
difficulty paying for care even when insured, and to encounter
time-consuming insurance complexity. Signaling the lack of timely access
to primary care, adults in the United States and Canada reported long
waits to be seen in primary care and high use of hospital emergency
departments, compared to other countries. Perhaps not surprisingly, US
adults were the most likely to endorse major reforms: Three out of four
called for fundamental change or rebuilding.

Insurance Design And Affordability

In this study, US adults — both the insured and the uninsured — were
more likely than adults in other countries to report going without care
because of costs, having high out-of-pocket costs, and having difficulty
paying medical bills.

Reforms scheduled under the Affordable Care Act provide for subsidies to
lower cost sharing for those with incomes below specified thresholds as
well as reductions in premiums for people with low or modest incomes.
However, by international standards, cost-sharing exposure will remain
high for those with low incomes. Also, states will have considerable
leeway in insurance design for middle- and high-income families, with
annual out-of-pocket maximums and deductibles that will continue to be
high compared to those in other countries. For people with chronic,
ongoing conditions, the result could be continued high medical cost burdens.

Insurance And Primary Care

Insurance design and payment policies also matter for access and
countries' primary care infrastructure.

The high rates of ED use associated with long waits for primary care in
the United States (including among insured patients) and several other
countries underscore the importance of 24/7 primary care coverage in
terms of overall system cost and resource allocation.

Insurance Complexity

The experiences of patients and physicians in other countries regarding
the time-consuming complexity of insurance also provide potential
insights for the United States.

A recent Institute of Medicine study estimated that administrative
layers throughout the US health insurance and care system add as much as
$360 billion per year to the cost of health care — and much of that sum
was deemed to be wasted, with little or no return in value. Evidence
from other countries suggests opportunities to reduce such costs.

Cost Control

A key challenge for the United States is its already high level of
health spending, which is 50–167 percent higher per capita than in the
other study countries. These costs undermine the financial protections
offered by insurance and drive premiums up.

Support For Reform

Polls in the United States show mixed public support and lack of
knowledge about the provisions of the Affordable Care Act. Yet in the
survey most US adults called for major change, with a minority
preferring the status quo. People who had experienced problems with
access to or affordability of care or who had time-consuming insurance
problems had more negative views than people who had not had such problems.

Comment: This 2013 survey sponsored by the Commonwealth Fund is very
helpful during the Affordable Care Act transition because it tells us
how the United States is doing compared to ten other industrialized
nations with universal systems. Our results are terrible, and when we
look ahead at the changes yet to be implemented, it is clear that they
will have an almost negligible impact on correcting the serious
deficiencies in the United States.

Our per capita costs will remain far higher than those of other nations.
Our insurance products will remain very expensive yet highly flawed in
design since they leave those individuals who have significant health
care needs with high medical cost burdens. The excessive complexity of
our insurance products will continue to waste hundreds of billions of
dollars that could be used on health care. Measures intended to provide
much needed reinforcement of our primary care infrastructure are all too
meager, so timely access to care will remain impaired for too many.

Three-fourths of Americans believe that we need fundamental changes or
complete rebuilding of our health system. We have a far greater
percentage dissatisfied than are in the other developed nations.
Although it will be several weeks before the exchange plans and the
Medicaid expansions will be in effect, most Americans will not be able
to detect any improvements in their health care financing and access.

In fact, many will have greater out-of-pocket costs because of increased
shifting of costs to patients through measures such as high deductibles,
and others will lose access to their current health care professionals
and institutions because of the greater use of narrow provider networks
- further reducing choices in health care. In spite of the noble
intentions of the Affordable Care Act, most of us will not see any
correction of the serious flaws demonstrated in this international
survey which shows how costly and dysfunctional our system is, and too
many of us will be even worse off.

As we watch the 2014 implementation unfold, we have to keep in mind that
it didn't have to be this way. We could have had and still can have a
single payer national health program - an improved Medicare covering
everyone. With what we spend, we should be at the top in these
international comparisons. Single payer would get us there.

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