bar graph illustration of climbing costsNow that I have your attention!

The Dallas Morning News article included in the Feb. 2, 2015 Mental Health Daily titled, “Cost of Care: The U.S. health care system is bleeding green” is an excellent read! Two compelling graphs (continuous rise in health care costs 1999 to 2014; 2013 per capita health care spending in developed countries) illustrate that the current financing model used to pay for health care in the U.S. (news flash!) is not only expensive but simply unsustainable.

We collectively spent just under $3 trillion for health care in 2013, translating to a cost of $9,255 per person. It is estimated that health care spending accounts for 17.4 percent of the nation’s economy.

Why? Well, there are lots of factors in play, but one of the main reasons is that our prices are so much higher — hospital costs, overhead, doctor’s visits, medications, medical devices, and salaries of health care professionals, particularly specialty providers. The other key factor is that we are in worse shape than previous generations. Our diets contribute to chronic health conditions such as obesity, diabetes and hypertension. Smoking and excessive use of alcohol also play a role. Place matters. People are living longer, with worse health. And let’s not forget the Social Determinants of Health!

How did it all start? The article takes us through a brief history of how and where it all started, from the beginning of hospital insurance to health insurance to the 2010 Patient Protection and Affordable Care Act (ACA). Interesting history to familiarize yourself with.

The ACA intends to provide a health insurance safety net for the uninsured and underinsured, many of whom have multiple chronic health conditions. We often hear, “they just need to pick themselves up by their own bootstraps (Texas talk).” That can work – provided you have boots, much less boots with straps!

We have been paying (yes, all of us) all along for persons with chronic health conditions to access health care who have no means to pay for it. It contributes to the rise of health care premiums for those of us fortunate enough to have health plans, access to a network of providers, and the financial ability to manage the co-pay. The saying,”If we don’t pay (invest) now, we’ll pay later,” never rang so true.

The article accurately points out that most of what we pay health care providers relies on a business model known as fee-for-service. Each provider or practitioner is paid on the basis of services rendered. It’s a system that has been called into question most recently because it creates an incentive to provide more care and often unnecessary care. Think about it: which provider stands to earn more, the one who sees you three times a year for a health condition, or the one who sees you three times a month (36 visits a year) for the same health condition? Which one costs more?

Policy implications are highlighted in the article. Many folks, due to high deductibles or inability to make the co-pay, are putting off until tomorrow what should be checked today. Could this mean higher expenses down the road? Of course, if you’re lucky enough to survive it.

In the months ahead, the “Cost of Care” authors will examine more closely the factors driving the cost of care and the exciting financing experiments and innovations happening around the country in an effort to contain and control health care costs. I’ll be on the lookout for the next article. I hope you will too.