Overwhelming the Healthcare System: Making Dollars and Sense out of Chronic Illness and its Future Financial Impact on the U.S.May 7, 2020 8:00 AM
“Normalcy”, “Normality”, “Normal”; No more. I’ve never heard the verbal and written abuse of a seemingly, well, normal, word as much as the six-letter description of what is supposed to be over the past three months. For those of us familiar with the U.S. healthcare system, we’ve discarded the word “normal” from our vocabulary long ago.
As many of us anxiously await the “end” of the most recent global pandemic one common phrase has stood out among healthcare industry experts as the most detrimental aspect of the recent outbreak: “overwhelming the healthcare system.” In short, overwhelming the healthcare system can be illustrated by imagining the hospitals in our areas completely overrun with so many COVID diagnoses that it affects the ability for facilities to manage and effectively treat regular hospital patients (not spurred by the pandemic) resulting in worsened health outcomes for all. Luckily, we will avoid a blanketed overwhelming scenario in the U.S. due to this pandemic, but that doesn’t relieve the concern of a looming explosion of chronic illness that is likely to take a similar path within the American population.
As we approach the 2020 political season, healthcare remains an eternal “hot topic” issue; one that acts as an economist’s reoccurring bad dream. Much like a bad dream, the obvious warning signs of our domestic system’s atrophy disappear into the cognition of the economist’s mind and are forgotten by mid-morning. The economist, much like the rest of the country, has an eerie feeling due to this reoccurring healthcare nightmare, but can’t quite seem to pinpoint the root of their discomfort or begin to answer the lingering paradox of “How can we make healthcare in the U.S. financially sustainable?”
The answer to that question is a large, complex, and convoluted issue to tackle. An alternative approach is to look at our ongoing mistakes as an industry and start to peel back some of the fraud, waste, and abuse at least long enough to get our collective head above water to propose a semi-legitimate long-term solution.
A recent article written by the Wall Street Journal outlines some startling financial data in regard to our domestic health insurers and their cryptic billing process established by CMS (Center for Medicare/Medicaid Services). Although GMS typically focuses on the private insurance markets—as they are the most relevant for businesses—examining the continued failures of CMS may provide some insight as to why our domestic healthcare system operates so poorly and why prices for both public and private health insurance markets are sky-rocketing.
Following a 19.1 percent-32 percent hike in 2018, 2019 Obamacare rates are expected to rise by double digit percentage points, again. Though speculation by market experts have resulted in a slew of responses as to why premiums have continued to rise, 2019’s increase is one of the most cut and dry responses by insurers to current reform changes. Within this article, we’ll explore the proverbial straw that broke the camel’s back, which happens to be one of the pillars the ACA was built on: the individual mandate.
As we brace ourselves for undeniable regulatory changes within the healthcare industry, often we neglect conversation about the shortcomings of our current system to ensure we don’t repeat the same mistakes. Although many would agree that the intentions of the ACA (“Expand access to health insurance, protect patients against arbitrary actions by insurance companies, and reduce costs”) were created with social good in mind, experts are strident that the mechanisms used to create this social good have failed to correct the economic epidemic that currently infects our healthcare system.
If you think “economic epidemic” is a hyperbolic term to use in this context, think again. As referenced in my previous blog post about the continuing battle to repeal the ACA, the U.S. domestic healthcare system costs around $3.3 trillion to the American economy each year. What’s less known is that this figure is projected to continue rising as it has almost every year since the 1960s.
Even if you only follow on the fringes of healthcare reform, the inception of the ACA in 2010 may have shed light on the lack of bipartisan effort surrounding reform policies. Regardless of which side of the political spectrum you sit, the ACA (Patient Protection and Affordable Care Act) is widely regarded as the most impactful healthcare policy since the rollout of Medicare & Medicaid by President Lyndon B. Johnson in 1965. Irrespective of the clout this policy holds in the eyes of leaders within our domestic healthcare system, it has not operated within its short eight-year tenure without controversy.
The debate surrounding the longevity of this policy continued last Thursday (June 7, 2018) in unprecedented manner as the Justice Department filed a briefing recommending that the U.S. District Court of Texas (Fort Worth Division) rule the insurance reform provisions of the ACA unconstitutional.