Letters: Status quo in healthcare is no longer an option

The article “Report: Patients’ out-of pocket costs increased up to 14%” is a stark reminder: With many American workers living paycheck to paycheck, even expensively insured families can face financial ruin from routine illness and injury. That dilemma is echoed on a national scale: with healthcare consuming nearly 18% of gross domestic product and rising, the question is not whether we can afford to change the system radically but whether we can afford not to.

Soaring healthcare costs are driving America’s wage stagnation problem. Employer-sponsored health coverage is compensation, and the cost has risen so fast that there’s little room for wage increases. When we ask how we can pay for universal health coverage we should remember that the amount employers and employees now spend on health coverage could become taxable income under a single-payer system.

Making the system affordable will require cost reductions, and the “public option” proposals will not achieve them. A single billing and payment system could address runaway administrative costs, and a single payer would have the leverage to control prescription drug costs. Economies of scale still exist. Hospital administrators worry about Medicare-level payments, but they would also lose the burden of uncompensated care.

The status quo is no longer an option. This is a crisis, and it needs an immediate and decisive response. Single-payer systems are working all over the world; they can work here too. We just need the courage to act.

Steve Rogers
Olympia, Wash.

Regarding “Rising prices drive estimated 6% medical cost inflation in 2020,” societal spending on healthcare isn’t just about prices. It’s the product of both prices and the volume of services utilized. We need to address both. 

We spend a large chunk of our healthcare dollars caring for people with multiple chronic and disabling conditions and providing care to patients in their last two years of life. In both cases, providers are mostly reimbursed by a single payer, our government, through Medicaid and Medicare, which already wield negotiating power to restrain prices. 

A more troubling problem than prices is the variation in the utilization of care without evidence of better health, longer life, or more effective or satisfying care for our higher spending. Simply put, some care providers achieve superior outcomes at lower prices and fewer services.

Price containment has been tried previously and failed because healthcare delivery systems offset lower prices through increased utilization of services. Meanwhile, blindly restricting the utilization of care is immoral.

To contain societal spending on healthcare requires an “all of the above” approach that addresses both prices and variation in the volume, quality and outcomes of services.

Thom Walsh
New York