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The Big Barrier to High-Value Health Care: Destructive Self-Interest
One of the best-kept secrets in the United States is that workers pay almost all of the costs of their health care. They do so through employee contributions to premiums, out-of-pocket payments for services, a shift of compensation dollars from wages to benefits, and state and federal taxes such as the payroll tax that supports Medicare.
But instead of serving workers’ best interests by trying to give them the best care at the lowest cost, insurers, providers, employers, and unions act like adversaries. Insurers leverage their purchasing power to exact discounts from providers and their administrative power to reduce benefits. Dominant providers leverage their market position to raise prices independently of cost or quality. Employers leverage their power in labor markets where workers have limited job options to extract higher deductibles and out-of-pocket payments from employees. Unions, which now represent a tiny share of American workers, resist to the extent they can.
The numbers spell out the sorry result. On average, family premiums and out-of-pocket costs are about 40% of median household income (and even more if the payroll tax for Medicare is included). Meanwhile, health care outcomes for the population as a whole are improving at a rate far slower than premiums are increasing. This continuing transfer from wages to health care does not reflect better value for money.
But instead of serving workers’ best interests by trying to give them the best care at the lowest cost, insurers, providers, employers, and unions act like adversaries. Insurers leverage their purchasing power to exact discounts from providers and their administrative power to reduce benefits. Dominant providers leverage their market position to raise prices independently of cost or quality. Employers leverage their power in labor markets where workers have limited job options to extract higher deductibles and out-of-pocket payments from employees. Unions, which now represent a tiny share of American workers, resist to the extent they can.
The numbers spell out the sorry result. On average, family premiums and out-of-pocket costs are about 40% of median household income (and even more if the payroll tax for Medicare is included). Meanwhile, health care outcomes for the population as a whole are improving at a rate far slower than premiums are increasing. This continuing transfer from wages to health care does not reflect better value for money.