Vox populi

Deductibles and the blame game for high health care costs

Polls and surveys this year (most significantly a Kaiser Family Foundation (KFF) poll in January) have found that Americans like the idea of Medicare for all. But tell them that it would mean giving up on employer-sponsored health insurance—as some Medicare-for-all plans propose doing—and those in favor swing from a majority into a minority.

Recently released results from a survey conducted by KFF with the Los Angeles Times didn’t aim directly at measuring the popularity of Medicare for all, but asked questions that may play into American attitudes. For example, the survey showed a direct relationship between dissatisfaction with employer-based insurance and high deductibles: the higher the deductible, the more likely workers were to give employer-sponsored health insurance a poor or failing grade. A finding from Captain Obvious? Maybe. But Medicare-for-all fans may be eyeing that group as one that could be swung to their point of view.

The higher the deductible, the less popular the plan

12% of high-deductible plans were rated as excellent compared with 45% of plans with no deductible in a Kaiser Family Foundation–Los Angeles Times survey.

Source: Kaiser Family Foundation–Los Angeles Times Survey of Adults With Employer-Sponsored Health Insurance, May 2019

Drew Altman, the Kaiser Family Foundation’s CEO, told the Los Angeles Times May 2 that “there has been a quiet revolution in what health insurance means in this country. This happened under the radar while everyone was focused on the Affordable Care Act.”

The ACA debate was mainly about how to provide insurance coverage for those who don’t have it. “We forgot that most people get their insurance through an employer, and for them, the issue is medical bills that they increasingly cannot afford,” Altman said.

One caveat: The survey was conducted online and by telephone from Sept. 25 to Oct. 8, 2018.

That’s months ago, and attitudes may have shifted some.

Looking for a scapegoat

Who’s to blame for the high price of American health care (now in excess of $10,000 per capita) was one of the many questions the Kaiser Family Foundation and the Los Angeles Times asked. Roughly six in 10 pointed a finger where you’d expect: at pharmaceutical companies and health insurance plans. Three in 10 blamed hospitals, and just 15% blame doctors.

The usual suspects

Pharma companies, insurers blamed for high cost of health care.

Source: Kaiser Family Foundation/LA Times Survey of Adults With Employer-Sponsored Health Insurance, May 2019

According to some analyses, high American health care costs can be traced back, in part, to employer-based insurance, the favorable tax treatment of premiums, and rich benefit packages (remember the perpetually delayed Cadillac tax?).

It’s an explanation with some integrity to it—the identification of a factor in a multifactorial chain of events—but only a small fraction (7%) of the public blame employers for high health care costs, according to the KFF–Los Angeles Times survey.

One reason it’s going to be an uphill battle for Medicare-for-all proponents is that Americans don’t see employer-based insurance as part of the problem of this country’s super-sized health care costs.

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