Anger over healthcare costs is at a breaking point

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The real anger about healthcare costs--the kind that could actually reshape healthcare delivery--is beginning.

Those grumblings are coming from Americans who for decades had to pay for little of their care but have been rudely slapped around in recent years. Systemic cost-shifting has given them far more fiscal responsibility in the way of increased deductibles and out-of-pocket costs. Some pundits had asserted this concept of "skin in the game" would force patients to be more selective about their care and reduce unnecessary utilization.

Except there have been profound problems with that concept. Consumers have been given next to no information about the cost of their healthcare. Those states that actually operate websites do so with extraordinarily limited data. It usually shows a wide range of what hospitals charge for a specific procedure, but absolutely no clarity on what they would pay based on their insurance coverage, and no mention of what ancillary services such as anesthesia would cost. 

No wonder the dry wit of Princeton University healthcare economist Uwe Reinhardt compares a consumer buying healthcare services to shopping blindfolded at Macy's. He's been using that line at conferences for the better part of a decade, and still gets a pretty good laugh every time. Except consumers have never found it funny. And now they're just getting extraordinarily angry, as several recent news items suggest. 

One was published over the weekend in The New York Times. The article included interviews with several people who purchased insurance through one of the state exchanges and then considered the coverage useless. They included Karin Rosner, a freelance writer who pays $300 a month for subsidized coverage. She fears she can't use the coverage to protect her eyes, which are prone to retinal detachments. Kevin Fanning, a resident of Texas, dropped his insurance because with a $10,000 deductible, he got absolutely pummeled as a result of an overnight hospital stay.

Terry Cessna wrote in the Chicago Tribune that he was "furious beyond words" regarding his wife's subsidized health plan being canceled and replaced with a policy that would cost her $282 a month--nearly quadruple what it was in 2014. Oh, Blue Shield and Blue Cross of Illinois also tacked on a $750 per day inpatient co-pay.

Rosner and Fanning struck me because they both earn about $30,000 a year. The facts in the Chicago Tribune article suggest Cessna is likely in the same boat. That means if they had asked their local hospitals for a charity care discount, all or most of their deductibles and co-payments would have likely been erased.

Of course, most hospitals do a woeful job of telling patients about their charity care policies, even though most are income-based and often cover those with health insurance who can't afford to pay their bills.

Meanwhile, those dwindling number of Americans who still obtain health insurance through their employers are now paying 130 percent more for their healthcare than a decade ago. If their wages had gone up 30 percent during that time, they would be doing relatively well.

If those patients aren't being pummeled hard enough when they pay premiums and obtain care, they'll take their lumps when they fill a prescription, as drug cost increases have been far higher than any other aspect of healthcare delivery. Their anger wasn't exactly assuaged when Martin Shkreli decided to buy a 63-year-old lifesaving drug and jack the price up more than 50-fold.

Little wonder a recent HealthDay/Harris poll found that 73 percent of Americans want price controls placed on drug and medical device manufacturers; 70 percent want price controls placed on hospitals; and 63 percent want price controls placed on doctors. 

"Most people want to see a lot of different actions taken to contain healthcare costs, including government price controls of providers, drugs and devices, and two controversial actions which are currently prohibited--allowing the importation of drugs from other countries and allowing Medicare to negotiate drug prices," Humphrey Taylor, chairman emeritus of the Harris Poll, said in a statement.

Actually, those last two aren't controversial at all. Importing drugs and allowing Medicare to negotiate prices are only illegal because the pharmaceutical lobby strong-armed Congress to make it so. The American people's input was never considered.

Given those poll numbers and the rising anger, that may soon change. How many more years will there be before large number of health insurance enrollees engage in a premium or co-payment strike if there's another outrageous increase? How much longer before some savvy lobby for consumers coalesces and extracts clearly delineated price data for hospitals in lieu of a patient boycott?

We are edging toward that moment, and providers should take note.-- Ron (@FierceHealth)

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