In case we’ve forgotten, there is other health news to report besides more cancelled insurance policies, website screw ups, and lagging Obamacare enrollment. Two topics showed up in the press in the last few days reminding us that health reporting is a big universe: One involves an annual check-up on how the US compares healthwise with the rest of the world; and the other looks into the past and shows how quickly a well-meaning law to provide catastrophic drug coverage for seniors turned into a political disaster.
Each year The Commonwealth Fund, a philanthropic organization interested in health (and, full disclosure, a funder of The Second Opinion) surveys eleven countries on healthcare affordability, access and complexity, examining such things as how easy is it to see a specialist or get primary care; how much do citizens have to pay out of pocket; whether people forego care, and how satisfied they are with their countries’ health systems. For the more than ten years that the Fund has conducted these surveys, the US has not stacked up well. This year is no different (to wit, UPI’s headline summarizing the report, “US healthcare: Most expensive, longest waits, most red tape.”).
• More than one-third of American adults went without recommended care, did not see a doctor, or fill prescriptions because of costs. In the United Kingdom only four percent reported these problems.
• In the US, 42 percent paid $1,000 or more out of pocket for medical care because of higher deductibles and other higher cost-sharing, a problem that might get worse as insurers continue to shift more costs to policyholders.
• When it came to paperwork and hassles with insurance companies, 32 percent of Americans had complaints. That compares to 19 percent in the Netherlands and 17 percent in Germany, countries that have competitive insurance markets similar to the US.
• Three-quarters of Americans said their health system must undergo fundamental changes or be rebuilt. In other countries, more than half of respondents had positive views of their systems. In England, for example, 63 percent said the system works well and needs only minor fixes.
• US and Canadian adults were more likely to experience long waits for primary care and high use of emergency rooms compared to other countries.
One story stood out for doing a bit more. In a blog post Thursday, NBC News’s Maggie Fox used the Commonwealth Fund study—as well as another study reported in the Journal of the American Medical Association—to challenge a recent assertion by House Majority Leader John Boehner that Obamacare would “destroy the best health care delivery system in the world” (a familiar Republican claim, particularly from early in the debate over the Affordable Care Act, and a claim that too often goes unchallenged by reporters).
“But is it, really?” asked Fox, who went on to cite specifics from the Commonwealth and JAMA studies demonstrating “quite the opposite.” Despite high US spending, now approaching almost 18 percent of GDP, Fox wrote, the US “is not keeping up with the rest of the developed world when it comes to improving people’s health.”
This was one of the big, thorny issues the Affordable Care Act was intended to address, by at least making it easier for the uninsured to buy insurance. A Monday New York Times piece by Carl Hulse explored how fragile the law could be. Hulse dug into the archives and recounted what happened in 1989 to a law meant to help Medicare beneficiaries pay for some of their drugs, and he drew parallels to what’s going on with Obamacare. Lawmakers learned the hard way, Hulse reported, that people the law was intended to help didn’t want to be helped the way Congress envisioned. Sound familiar? In the last few weeks, people who shop in the individual market have been squawking loudly about insurers cancelling their policies which don’t meet the essential benefit standards set by the ACA. In short, they don’t mind having zero coverage for maternity care or mental health problems, and they don’t see any reason to pay higher premiums for those who do need it.
In 1989, Medicare beneficiaries also squawked loudly. Some already had prescription drug coverage and didn’t want to pay a supplemental premium for those who didn’t. Mindful of the backlash, Congress quickly repealed the law. Will the same thing happen again? Many people Hulse interviewed doubt it—including one of Obamacare’s biggest cheerleaders, Ron Pollack, who heads Families USA. Pollack argued that the law’s benefits flow to too many people, and the costs are spread among too many to be reversed. (My colleague, Brendan Nyhan, offered his take on “worst case scenario” reporting earlier today). Still, Hulse’s piece was well written and points up something that, in my opinion, remains unresolved and often left out of coverage: Is everyone entitled to heathcare with everyone chipping in to pay for it?
Money is the common theme in Hulse’s story and the stories invoking the Commonwealth study. When it comes to healthcare, are we getting what we pay for and who bears the cost burden? One of the five threads reporters really missed on Obamacare, as I wrote last month, is adequate explanation of how Obamacare is financed and why. And for the most part, this is still missing in coverage.
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