National debt has been center stage in Washington, D.C. (and every single news outlet), for most of this year. What hasn’t been given the spotlight is the primary driver of our long-term national debt: the cost of health care.
Rising costs and affordability have been the most critical issues in health care for decades. That’s because health care costs have been rising the entire time. In 1970, we spent around 7% of our GDP on health care, and consumers and policymakers were already worried about costs and affordability. By 1990, that percentage had risen to more than 12%. Today, it is more than 18% and likely to climb further in the years ahead. Health care costs have risen faster than wages and other prices in the economy almost every year for as long as any of us has been alive. And that means it’s becoming harder and harder for Americans to keep up.
To compound this issue, we know our aging population is expected to grow significantly over time. Because people 65 and older, on average, spend more on health care than any other age group, we know it will contribute substantially to the cost of care in the years to come. In fact, the Congressional Budget Office projects Medicare spending will double over the next 30 years relative to the size of the economy.
I think it’s fair to say that rising costs are the central problem in health care. Most of the other problems — especially access to care — would be far easier to solve if we could just make it more affordable.
But that’s not easy to do.
It’s not easy because our health care system is a tremendously complex mix of hospitals, doctors, nurses, drug companies, device manufacturers and others, all of whom want to both contribute to making care better and be paid for their efforts.
It’s not easy because our health care system is a tremendously complex mix of hospitals, doctors, nurses, drug companies, device manufacturers and others, all of whom want to both contribute to making care better and be paid for their efforts.
We’ve made this even more difficult because of the way we pay for health care in the United States. Most health care, whether funded through Medicare, Medicaid, or private insurance, is paid for on a “fee-for-service” basis. A doctor performs a service, and the government or private insurer pays them a corresponding fee. If the service is more complicated or expensive, the provider gets paid more. And when we need health care, we’re typically not interested in bargain shopping; we’re looking for the best care for ourselves and our loved ones.
If my family member needs a medical procedure and it costs more to the government or our employer-funded plan, so be it.
What that means is our entire system is set up to often provide us with more care than we need. And since we aren’t bargain shopping, that additional care comes with a hefty price tag. Each individual case, for you or a loved one, adds just a little to overall health care costs. But when you apply it across the entire system, year after year and decade after decade, it adds up. Which gets us to where we are today — with health care being the primary driver of national debt, and the United States having the highest health care costs in the world.
Here’s what makes this especially challenging: the bulk of our costs go to the people who need care the most. According to the Kaiser Family Foundation, we spend more than 20% of our health care dollars on 1% of the population, and we spend nearly half on 5% of the population. These are people who really need care — people with metastatic cancer, people with multiple chronic conditions, victims of traumatic accidents, babies born prematurely, just to name a few.
There are ways to make this care less expensive, but we must do so carefully, thoughtfully and always in a way that gives these patients the care they need. At Blue Cross Blue Shield of Kansas, we strive to pursue affordability relentlessly and creatively, but not in a way that lessens our members’ experience with their health.
So why am I telling you all this? What does all of this mean to you and your loved ones? Simply put: We all have a stake in the future of health care. We need to not only give Americans access to quality care, but also to care they — and we as a nation — can afford.
Many of our problems as a country, from the national debt to inflation to job growth, are made worse because health care in this country is so expensive. It also makes it harder for every business and every family to balance their own budgets. If we’re going to solve these problems, we need to begin to think differently about health care.
But we can’t do this by ourselves. We need everyone involved in the system — from hospitals to policymakers to citizens — to keep costs and affordability in mind as they work to make care better for themselves, their communities and the nation as a whole.
Matt All is a fifth-generation Kansan who brings more than two decades of experience in leadership and service to his role as president and CEO of Blue Cross and Blue Shield of Kansas. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.
