Tuesday, September 22, 2009


From Ezra Klein at the Washington Post, a startling article about what the average American wage earner is already paying for health care:

The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.

Three years of slightly above-average health insurance will cost a solid six figures.

Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.

About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.

As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.

Klein argues that if most Americans really understood what health care was costing them, they'd be begging for reform. The greatest costs savings in the current proposals, he adds, would come from small fixes and the magic of medical IT:

For instance, despite all the fire over the co-op plan, it gets two pages in the Finance Committee's bill. Pages 75 to 110 are all devoted to delivery system changes that are meant to make the system a bit more efficient but that no one has ever heard of. "Value-based purchasing" alone gets six pages in the bill. The "National Pilot Program on Payment Bundling" gets another five.

Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by "modernizing" the system over the next 10 years. The changes they examined weren't dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, "bundling" payments for the treatment of a single illness rather than shelling out separately for each doctor visit -- that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That's a lot of money for policies that have received virtually no attention in the debate.

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