Editor’s note: Marvin Malek, MD MPH, is an internist practicing in Berlin.
Over the last month, opponents to Vermont’s health reform have come up with a novel rationale for delaying or aborting the reform: that health inflation has been tamed even before the national or Vermont’s state-based reforms were rolled out. (VTDigger Feb. 5, 2014)
In fact, for three main reasons, health cost inflation has moderated considerably during the last 10 years:
• This has been a decade remarkably devoid of major new pharmaceutical breakthroughs. This has meant an increase in prescribing of less expensive generic medications and a sharp decline in pharmaceutical cost inflation.
An explicit goal of the Vermont’s single payer reform effort is to create a system in which major financial burdens would not be imposed on those attempting to access needed medical care.
• There has been an increase in high deductible plans — 38 percent of the U.S. population is now insured through such plans, with the average deductible nationally at $1,040. High deductible plans discourage non-wealthy families from utilizing health services — including services that might benefit them. This is not the ideal way to control health expenditures. In fact, a recent New York Times poll found that under 5 percent of the U.S. population was even aware that health cost inflation had declined, likely because the out-of-pocket medical costs for them have actually increased. (New York Times, Dec. 19, 2013)
• Another factor is the recession itself: Elective procedures — ranging from hip replacements to plastic surgery — dropped considerably with the onset of the Great Recession in 2008. And the number of elective procedures has shown only a minimal increase since 2008, presumably due to poor recovery of employment and wages.
It’s noteworthy that two of these factors relate to the unaffordability of health care to individuals with moderate or low household income. For the last 20+ years, health care has been unaffordable to over 25 percent of the population both in Vermont and nationally. And unfortunately, virtually all the plans being offered under the Obamacare reform continue to impose high deductibles and other major financial deterrents to care.
An explicit goal of the Vermont’s single payer reform effort is to create a system in which major financial burdens would not be imposed on those attempting to access needed medical care. So if anything, the recent news on health costs should increase the impetus for reform: Health cost inflation may be moderating and yet more of Vermont’s families are facing unrelenting financial barriers to care.
I personally believe that opponents to reform would have contorted any type of news on health cost inflation into a rationale to delay or abort the reform effort. With health cost inflation temporarily moderating, the opponents are arguing that the reform isn’t necessary. Had the news been that health cost inflation had risen to higher than expected levels, then these same individuals would have likely argued that the reform effort should be aborted due to unaffordability.
Those working on implementing Vermont’s reform will face many challenges in their effort to successfully create a universal health care system in Vermont. But none of the news that has emerged regarding health cost inflation ought to deter our reform effort.