Office Hours with Dr. Saini – Healthcare affordability: How did we get here?

Healthcare costs have become one of the largest political issues, with a majority of voters on both sides of the aisle worried about affording care. Given our vast wealth, technological advances, and high-quality hospitals, how did we get to the point where the average American can’t afford the medical care we need?

In a new video series, “Office Hours with Dr. Saini,” Lown Institute president Vikas Saini gives his take on healthcare affordability topics, one question at a time. This week’s question is simple: How did we get here?

“We need reforms that are much deeper and much more radical than people are willing to talk about.”

Dr. Vikas Saini

Welcome to office hours with Dr. Saini! I’m Dr. Vikas Saini, president of the Lown Institute. In this series, I’m going to give you my honest take on the American healthcare system. We’re going to do it one question at a time. And the first question we’re going to tackle is why is the American healthcare system so damn unaffordable?

And before I go on with that, you should know that the Lown Institute is doing a conference on this very topic this May in Boston. I hope we see you there.

So when did American healthcare prices spiral out of control? Is there a time that it sort of went broke?

Well, it’s interesting when you look at that question. The United States is seen to be an outlier famously all across the developed world. But when you look at the data that started at a given time and has continued and gotten worse over the last 40 years. When did it start? Late 1970s around 1980 or thereabouts. What are the causes of this affordability problem? Well, look, many of them are deep and entrenched and I’m not going to lie on that. Some of it’s an aging population. We’re not going to fix that. Some of it has to do with the new technologies that work and do amazing things and they are inherently more expensive and we have to be able to figure out how to finance that so everybody can benefit. But some of it has to do with rent seeking, some of it has to do with monopolization, and a lot of it has to do with a very unbalanced delivery system in which specialty care predominates and primary care is withering away on the vine.

So, why does it feel like everybody’s talking about it right now?

Well, it’s kind of obvious just because of the politics in the country at the moment, the results of the last election, polling data. But let’s pull back a little. I think the underlying thing that’s driving this is that we’ve kind of cut off working class people at the knees in terms of their income, but American healthcare hasn’t downsized its prices to match. So we have a growing affordability gap for larger and larger numbers of people. That’s the fact. Now when you start understanding that, you begin to recognize that we’re operating on an old model. In many ways, we’re kind of delusional about what the real state of affairs is in health care. More and more people simply cannot afford the basics. And the idea that we’re going to reform our way out of this really has to have a hard look. Sure, we need reforms, but we need reforms much deeper and much more radical than people are willing to talk about.

What are the what are the ways the affordability crisis is showing up in people’s lives?

Well, medical debt is one obvious one, but that is actually the final pathway. But for all the people in medical debt, there’s thousands, if not millions of people who have taken up the burden and paid the bills, but it’s really taxed their take-home pay. So when we’re looking at the question of affordability, we can’t just look at the people who are uninsured or the people who are in debt. We have to look at everybody. And the frightening thing, I think, to more and more people, including to upper middle class people, is that more and more of them are facing lifeboats. They’re looking at whether or not they’re going to be thrown overboard or not. and the relentless pace of rises of healthcare costs are going to trap more people in the debt spiral.

So, is this crisis solvable?

Well, the short answer is absolutely it’s solvable, but you need the political will. What we do not have is a broad supermajority coalition to drive through the necessary changes. Of course, we don’t have full agreement on those changes, but what we do have, and I think polling increasingly shows this, is we have a super majority in the country, red states and blue states, of people who really want healthcare to be fixed, to be affordable, and to allow them the kind of dignity and autonomy in their health decisions that everybody wants for themselves.

Well, that’s all the time I have today, but I’ll see you next time for Office Hours with Dr. Vikas Saini.