New Orleans       These days a new year means a notice from your health insurer, if you have one, both private and public, of the amount of the increase in premiums or deductions from your Social Security checks.  With the Trump budget bill it will also mean changes coming in the amount of subsidies for polices offered on the Affordable Care marketplace, which is still open until the middle of January, which is another way of saying that millions will lose coverage.

It’s hard not to feel helpless, since so much is out of your control.  Private health insurance means covering the risk of illness by either paying the piper or gambling on another healthy year.  Not using the benefits of the coverage yields no personal benefits.  It’s not like seeing a reduction on your car insurance because you didn’t have any accidents or speeding tickets.  There’s no reward for good health, except of course that good health is absolutely better than bad health.  Because of that, health providers and insurers lay down a steady drumbeat of what we should do, individually, to stay healthy by eating better, exercising more, laying off the drinking and smoking, sleeping more, and the beat goes on.  We can do all of those things or a good amount of them, and still see our costs rise 10% or more, since we are a captive market for them.

Why the costs so high and what could be done about them is worth some thought.  The former head of the Office of Management and Budget under Obama, Peter Orszag, made some interesting points recently, pointing the fingers away from us and at the real drivers of higher prices.  Here’s what he underlined:

• 25% of the costs are estimated to be waste, which could be lowered with more “evidence-based approaches to care.”
• High-cost, high-complexity cases drive spending. The costliest 5% of the population accounts for “about half of health care spending, while the most expensive 1% drives over 21% of the cots.” Don’t misunderstand me, I’m not begrudging these folks efforts to live, but I’m not sure why we’re all subsidizing it exactly?
• Studies have found that spending per person varies significantly by region “with no correlation between higher spending and more effective care.
• Another study within the Military Health System found that 80% of regional spending “has nothing to do with patient conditions…[with] higher costs largely a function not of sicker patients, but of local medical culture that favor more aggressive care,” meaning more tests, days in hospital, and more procedures.

This is a systemic issue, not an individual one.  Maybe applying artificial intelligence will help cut back on unnecessary procedures, which seems to already be happening in heart and cancer wards.  Orszag argues that uniform standards on medical malpractice might help, as well as flat rates for standard visits and procedures.