Something's Wrong When Health-Care Coverage Costs This Much

(Bloomberg Opinion) -- One of the biggest arguments marshaled against substantial U.S. health-care reform is that Americans – particularly those with employer coverage –  fear disruption of their current private plans. Perhaps they shouldn’t be so scared of giving it up, as costs continue to skyrocket and eat into their wages.

A yearly survey released Wednesday by the Kaiser Family Foundation revealed that for the first time, the average annual cost of family health coverage among employer-sponsored plans topped $20,000 – some 54% higher than it was in 2009. And while employers shoulder most of the burden for family coverage, the $6,015 average employee contribution is 74% higher than it was 10 years ago. That’s far from trivial for low-income families, and doesn’t even cover all their costs. 

Premiums are just the start, especially when people get sick. Deductibles – the set amount many insured people must pay before their coverage kicks in – have been rising even more rapidly than premiums, according to the Kaiser data. Most workers that need care or prescription drugs have substantial co-payments or co-insurance to deal with as well. Some costs are less visible, like the thousands of dollars that employers spend on premiums and care that they can’t use to pay workers more.

And remember, the Kaiser data reflect averages. Plenty of Americans with employer coverage are substantially worse off. Families that get coverage from smaller firms, for example, face higher premiums and deductibles. 

The prospect of change is scary, especially when it comes to something as personal as health care. But health reform could be of substantial benefit even for people that are in the supposedly “good” part of the system. On the milder end of the reform spectrum, public-option plans would create a cheaper and potentially subsidized alternative for Americans who aren’t happy with their employer coverage. Several proposed plans from Democratic presidential candidates would also improve things for those who stay with their current employer coverage by raising standards or regulating provider prices. 

A single-payer plan such as Senator Bernie Sanders’s “Medicare for All”  is more controversial because the switch to government-sponsored health care wouldn’t be optional. But it would also have the best chance to bring costs substantially down. The coverage people would move to would be substantially more generous than what they currently have, with no premiums or out-of-pocket charges for care. Taxes would go up, but some of that would likely be mitigated, at least according to economists, by higher wages as employers would be able to redirect the boatloads of money they shouldn’t be spending on inefficient and expensive health care.

There are plenty of uncertainties associated with any health reform. But there’s one near certainty associated with keeping our current fragmented system: Health costs are likely to keep rising until the annual cost of family coverage is equivalent to a luxury car instead of an economy model. 

To contact the editor responsible for this story: Beth Williams at bewilliams@bloomberg.net

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

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