I’m a couple weeks behind on this, but I finally watched Jon Stewart’s January interview with HHS Secretary Kathleen Sebelius. (part one, part two). I like Jon Stewart. I think he does a great job of pointing out inequality and voicing concerns for people who might otherwise not have much of a voice in the public arena. And of course, he is quite skillful at making us laugh, regardless of how dry the actual topic at hand might be.
I enjoyed Jon’s interview with Secretary Sebelius. They both made a lot of good points, and for people who aren’t aware of how the ACA will impact health insurance regulation, the interview is a quick, entertaining summary. I couldn’t help but notice, however, that the entire interview focused almost entirely on health insurance. There was a discussion about how the states are going to be allowed to define their own essential health benefits, and about how the health benefit exchanges will impact (or not) the way in which people get their health insurance (from an employer or in the individual market via the exchanges). There was talk about the medical loss ratio (MLR) rules that require insurance carriers to spend at least 80 – 85 cents of every premium dollar on medical services (meaning only 15 – 20 cents can be spent on administrative costs). They discussed pre-existing conditions and the fact that starting in 2014, health insurance companies won’t be allowed to exclude pre-existing conditions or deny coverage to people based on medical history.
What they didn’t talk about was healthcare. My first concern is the fact that simply having health insurance is not a panacea. It does not guarantee access to quality healthcare. And more importantly, even if we could wave a wand and insure everyone in the country right now, we’d still be facing a very big problem: spiraling healthcare costs. It would be great if we could insure everyone and cap health insurance premiums at a universally affordable level, but it just doesn’t work like that. Healthcare spending in the US nearly doubled in the first decade of this century. Health insurance premiums go up because we keep spending more and more money on healthcare. We’re taking more prescription drugs than ever (including children). The percentage of Americans who are obese continues to climb, as do the associated healthcare costs. Patients with health insurance tend to be insulated from the actual cost of their care, but they also tend to want the best and most convenient care available. We love new technology, and the healthcare marketplace is filled with new technology, some of which is very expensive.
The reasons for our rapidly rising healthcare spending are complicated and numerous. It’s not something that can be hammered out with a quick fix, especially if we’re focusing so much on health insurance. As long as our healthcare costs keep going up, health insurance premiums have to keep rising as well. If they don’t, the health insurers will not be taking in enough money to cover claims, and there’s no way that’s sustainable (regardless of whether the health insurance in question is public or private).
I get the point that Stewart and Sebelius were making. They were addressing the aspects of the ACA that most directly impact people, since health insurance tends to be where most of us interact with healthcare costs. And the interview did – very briefly – touch on healthcare costs when Stewart mentioned that one of the reasons wages have stagnated is because “healthcare costs keep going up.” That is a key point, but they seemed to only be addressing it from the standpoint of health insurance premiums continuing to go up. It’s true that the actual check the employer writes each month to cover healthcare is paid in the form of health insurance premiums. But we have to address the root cause here, rather than just trying to figure out how to reign in premiums.
Steward did ask – in his usual joking manner – whether we all need to start exercising and eating better, which also touches briefly on the idea that a healthier nation would have lower healthcare costs. But overall, nearly the entire interview focused on how the ACA will impact health insurance. While that makes for an interesting interview, it also presents the ACA (at least as far as pop culture is concerned) as health insurance reform rather than healthcare reform. While there were definitely aspects of health insurance that needed reform, addressing health insurance as if it’s the crux of the issue is very much putting the cart before the horse.