Overuse Of Health Care “Crisis” Label Blocks Facing Policy Reality
Although President Richard Nixon declared health care costs a “crisis” in 1969, and every president … [+]
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The phrase “health care crisis” long ago evolved into an incantation, magic words meant to somehow summon public attention.
Mostly, that’s harmless. But a close look at a column entitled “Two Health Care Cost Crises,” from health policy establishment pillar Drew Altman, suggests that too much crisis-mongering can impede the crucial task of facing political reality.
If you don’t recognize the name “KFF,” it’s because the Kaiser Family Foundation gave up trying to explain it wasn’t part of the Kaiser Permanente health plan and adopted a moniker made up of initials, like AARP retiring “retired.” Since becoming KFF’s president in the 1990s, Altman has built the group into a widely respected source for thoughtful and independent health policy research, polling and news.
In his column, Altman asserts that the crisis involving national health expenditures and the crisis involving costs for individuals should be analyzed separately. For example, addressing the second crisis by increasing health insurance subsidies can exacerbate the first one.
Valid insights, to be sure. My focus, however, is on the impact of the casual application of the “crisis” label. A crisis, after all, demands action. But as I wrote for Health Affairs Forefront in 2018, the first president to declare health care costs a “crisis” was Richard Nixon back in 1969. They’ve been called a “crisis” or “unsustainable” by every president since. “How can a ‘crisis’ last for half a century?” I asked.
Of course, it can’t. A genuine crisis generates a crisis-level response. In health care, for example, warnings that the Social Security trust fund faced bankruptcy because of soaring medical costs prompted bipartisan legislation in 1983 that fundamentally changed how hospitals are paid by Medicare.
Is national health care spending at a similar crisis point? Altman himself concedes that the current stabilization has made it a “chronic” issue – except he can’t bring himself to say “issue” or “problem.” Contradicting his own diagnosis, we have a “chronic” crisis.
This linguistic misuse has a real-world impact. Constantly invoking a crisis turns it into background noise, the equivalent of “The Boy Who Cried Wolf.” Today, immigration is a domestic crisis. National health care spending isn’t. Everyone can see that.
If you care about health care spending crowding out other pressing needs, a problem liberals and conservatives alike agree is important, you need to effectively respond to the policy environment as it is, not as you wish it would be. Altman, a political scientist and former state and federal government official, is ideally suited to set an example for his policy colleagues by breaking the “it’s always a crisis” spell.
The question of the “crisis” of individual health care costs is trickier. Altman cites an award-winning investigation of medical debt by KFF Health News and partner organizations which concluded that 100 million Americans – 41% of all adults – are saddled with medical debt they can’t pay. It’s a number so startling it demands attention. It also raises question.
The figure comes from a KFF survey of 2,375 adults. KFF is well-stocked with methodological experts, so I’ll confine myself to the “sniff test.” Where is the evidence apart from this survey that 100 million American adults are saddled with medical debt they can’t pay? If 41% of all adults were suffering in this way, you’d expect to see some public display of anger and anguish equivalent to other burning issues – like immigration.
There certainly have been vocal protests about certain elements of cost, such as insulin prices or surprise medical bills, as Altman notes. Has addressing those defanged the larger crisis? Did the subsidies of the Inflation Reduction Act reduce what had been a crisis to a chronic problem? KFF has researchers and journalists who know how to challenge their own assumptions if they are asked to do so.
Speaking of challenging assumptions, Altman might also charge his researchers and journalists with actually asking the victims of medical debt what actions they think should be taken. For instance, might sizable numbers of those in debt prefer to suffer financially rather than risk the consequences they’ve been told “socialized medicine” would bring if there were universal coverage? Or have they become universal coverage advocates? Might some prefer personal debt to more government debt? Do those hurt by high-deductible health plans understand that those plans were championed by conservatives to make them better “consumers”? Do those in debt due to “skimpy” health plans have the same horror about them that liberals harbor, or as conservatives assert, would they still prefer something over nothing?
The opinions of a group representing 100 million people could be a powerful political force. KFF is uniquely positioned to obtain them.
Meanwhile, while Altman rightly bemoans high hospital prices and supports making pricing transparent, he says nothing about transparency regarding the quality of medical care. Given my own focus, I find it immensely frustrating that someone of Altman’s prestige and influence only mentions care outcomes – what we’re getting for our money – in order to repeat the well-worn statistic that U.S. life expectancy is less than that of other wealthy nations that spend less on care than we do.
Yet as Altman surely knows, National Academy of Medicine reports have concluded that up to 40% of health care expenditures are wasted on overuse, underuse and misuse. That 40% affects not just individuals’ wallets, but also their well-being due to diagnostic and medical error and ineffective or unnecessary care. Compassion for one segment of our society is no reason to overlook the profound physical and economic consequences to which all of us are vulnerable due to the wild variations our care system continues to tolerate in everyday care.
The Leapfrog Group estimates that some 160,000 lives are lost every year from the group of avoidable medical errors it tracks in its safety reports. If you only looked at moral factors, not political reality, you might even call it a crisis.
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