Just because you have a lot of medical insurance doesn't mean you can receive a lot of medical care.
One reason the United States spends more on health care than other countries is because we are obsessed with health insurance, not health care.
When Britain's National Health Service and Canada's Medicare system spend extra money, they spend it on things like hiring doctors, building hospitals, and buying medical equipment. When the U.S. government spends more money, we pass it on to insurance companies.
Get Obamacare. We currently spend $214 billion a year insuring people through Medicaid (mostly outsourced to private insurance companies) and the Obamacare exchanges. It costs every American household $1,731, and taxpayers send a huge amount of money to insurance companies every year.
What do you get for all that spending? Are people getting more health care? If so, what difference does it make?
Apparently, very few people find these questions interesting. Google
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Doctor visits have decreased
Nevertheless, one academic research It turns out that overall U.S. health care costs have not increased since the enactment of Obamacare. See below for more details. In fact, the number of doctor visits per person has declined over the past decade. That's amazing. The population is agingolder people need more medical care.
Unfortunately, there's nothing particularly new here. When Obamacare was enacted, it was expected to cost nearly $1 trillion over the next 10 years. But there was no serious discussion in Congress, in the mainstream media, or in the health policy community about what all that spending would buy.
Econ 101 teaches that all societies face a production possibilities frontier. A typical textbook example is choosing between guns (a munitions item) and butter (a consumer good). In our case, that's healthcare and other goods and services. To have more of one, you must have less of the other.
To get more medical care, we need more doctors, more nurses, more hospital beds, etc. Without an increase in supply, for people in one group to have access to more care, people in other groups must have access to more care.
We've seen this clearly during the coronavirus pandemic. To meet the needs of a surge in coronavirus patients, health care providers have had to delay care for non-coronavirus patients.
throw money at the problem
Our experience with Obamacare is similar to our experience with every major health care program that Congress has passed or considered passing. We start by advocating for unmet needs. We decide to throw a lot of money at the problem. But we never ask how money can meet unmet needs if we do nothing on the supply side.
Medicare for the elderly and Medicaid for the poor were large programs even when they began in 1965. In a short period of time the number of people without health insurance fell from nearly 25% of the population to less than 15%.
As a result, doctor visits among low-income people increased by 6.2%, and surgical procedures among the elderly increased by 14.7%. However, because the capacity of the system to provide health services did not increase, these increases were offset by a reduction in the care provided to non-poor and non-elderly people.research in American Journal of Public Health I found that.”Medical utilization throughout society will not change.”
Although medical services for the elderly have increased, MIT Professor Amy Finkelstein They found that passing Medicare had no effect on the health of older adults, at least as measured by mortality rates. However, the additional spending caused medical cost inflation for all patients.
What lessons have Washington politicians learned as a result of this experience? Apparently, not at all.
During the first term of the Clinton administration, Hillary Clinton proposed a plan to reform the private health care system and provide coverage to the uninsured. But while thousands of pages of analysis and debate went into the proposal, few asked what the public would have to cut back on in order to receive more health care.
No overall increase in healthcare utilization
Under Obamacare, the number of people without health insurance is 15.5 percent of the population in 2010 to 7.9 percent by 2022. However, the study cited above found that healthcare is used across society. It didn't increase at all. There were some changes, as low-income patients received more care, but that care was offset by cuts elsewhere in the system. In particular, “her 3.5 percentage point increase in the proportion of people with incomes at or below her 138% of the federal poverty level in at least one office visit was offset by the following effects:” Among the rest of the population, there is a small and non-significant decline. ”
You may think that prescription drugs are different. If Congress liberalizes drug insurance, drug companies will be able to supply patients with just the amount they want. But even in the field of pharmaceuticals, Congress's ability to waste taxpayer dollars seems to have no limits.
When Congress created Medicare Part D to pay for drugs in 2003, the federal government created $15.6 trillion in unfunded debt with an indefinite future. This was more than Social Security's unfunded liability.Yet an economist Andrew Rettenmayer It turns out that only 7% of the benefits actually bought new medicines for older people. The remaining 93% simply sent the government (i.e. taxpayers) a bill for drugs that seniors and their insurance companies had already purchased. Only $1 in every $13 is equivalent to purchasing a new drug.
What is interesting is that aid was given to a small number of people who were not taking any other medications. actually reduced Medicare spending., as more expensive doctor and hospital treatments have been replaced by drugs. But this benefit to those truly in need was overwhelmed by the cost of providing benefits to those who did not need them, a cost that imposed significant obligations on current and future taxpayers.
