US Suffers Pain from Rising Health Care Costs

Published in Nanfang Daily
(China) on 14 September 2012
by Xiaozhong Liu (link to originallink to original)
Translated from by Xinlin Xu. Edited by Laurence Bouvard.
Recently, a report from the U.S.-based Kaiser Family Foundation revealed that in 2012, annual premiums for employer-sponsored health insurance, which covers about 1.49 billion people, has risen four percent, to an average of $15,745 dollars. While lower than the nine percent increase in 2011, it still outpaced growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). The report also expects that, in 2013, premium growth will be seven percent.

The premiums for employer-sponsored health care are part of companies’ labor cost. Thus, the increase in employer-sponsored health insurance premiums can be considered as employee income with specified use and thereby, the corrected income growth rate should be 5.7 percent, but since the pricing of medical services in the U.S. is mainly oriented by commercial insurance institutions, employees cannot have a say in the cost of medical services, which means the employer, in order to cope with the rising cost of medical insurance, must issue part of the employees’ salary in the form of premium expenditure, thereby reducing the employees’ discretionary income.

Currently, rising health care costs in the U.S. are again pushing Obama's health care reform bill into the eye of the storm. According to the most recent poll, voters are most concerned with the increasing cost of medical services and health care plans for the elderly. Americans are increasingly worried that once the health care reform bill is formally implemented in 2014, medical costs will be pushed even higher. After all, relevant data shows that the new medical reform will augment the national budget deficit by $5.68 trillion dollars. With $14.3 trillion dollars national debt already there, the even larger deficit would mean residents and businesses in the United States will need to pay more tax to fill the fiscal gap created by the new health care reform.

Frankly speaking, the U.S. health care system is the most expensive one in the world. U.S. annual total expenditure on health care accounted for 17 percent of its GDP, about $2.4 trillion dollars, of which government health expenditures make up 46.2 percent; also, PwC [PricewaterhouseCoopers] claims that unnecessary medical service fees and price fraud account for half of the total national medical expenditure, approximately $1.2 trillion dollars. This situation originated from the increasingly serious lemon phenomenon* in the American medical market. Since the United States adopted a voluntary, instead of mandatory, health insurance system, insurance companies, based on self-interest considerations, are unwilling to provide insurance for the elderly over 65 years old, as well as for those people with poor health. However, since the young and healthy are reluctant to join insurance plans due to the high premiums, the lemon phenomenon* of the U.S. insurance market is thereby further aggravated.

Obama’s new medical reform has encountered strong opposition. One reason for such opposition is that, though the United States has an uninsured population of 32 million, these people are not the poor or the elderly who have no insurance plan, but those who neither qualify for state assistance nor are earning enough income, as well as those who think they won’t get sick and those who are reluctant to be insured because of the high premiums.

The second reason is that, though the health care reform requires review of insurance premiums, as well as a mandatory health insurance policy which aims to curb insurance company practices such as refusing to provide insurance for people in poor health and forcing young people to be insured, the health care reform can hardly alleviate the lemon phenomenon in the U.S. insurance market effectively. For instance, though the new health care reform requires insurance companies not to refuse to insure people with poor health, commercial insurance companies can still increase the difficulty for those people to get insured by means such as delaying approval. Meanwhile, insurance companies can adopt various preferential measures to attract young people, thereby absorbing a large number of them while forcing unhealthy people to buy medical insurance through the government. Obviously, this will make the government assume most of the medical expenses and will in turn push health care costs even higher and make the fiscal deficit larger. Such considerations trigger Americans’ worry about the new health care reform.

Health care costs in the U.S. continue to rise, increasing the burden for American businesses and residents. It is foreseeable that after the presidential election this year, no matter who assumes office, the new president will have to renovate measures required by the health care reform, or modify the health care reform bill, to reduce the constantly rising medical costs.


*Editor’s Note: Lemon phenomenon is an economic term referring to adverse selection by sellers (here, the insurance companies) and information asymmetry between sellers and buyers, where insurance companies have an advantage in discriminating against the ill while making up new rules or policies to attract the young and healthy, regardless of how the reform is carried out.


近日,美国恺撒家庭基金会等发布的一份报告显示,2012年医疗,覆盖约1.49亿人的雇主赞助医保计划的保费增长4%至15745美元,尽管低于2011年9%的增幅,但已是同期1.7%的工资增幅和2.3%通胀之和,同时该报告预计2013年的保费将增长7%。

  由于雇主赞助医保计划保费实为雇主用工成本的一部分,因此尽管雇主赞助医保计划的保费上涨可看作是雇员的特定用途收入,即折算下来雇员收入增速应为5.7%,但由于美国的医疗消费价格主要以商业保险机构定价为主,雇员无法左右医疗消费成本,这意味着雇主为应对医保成本上升,而把部分本应以雇员工资形式发放的收入变成了保费支出,进而降低了雇员的可自由支配收入。

  当前美国医疗成本上升,再度把奥巴马的医改法案推向风口浪尖。最新民调显示,医疗成本攀升和政府针对老年人的医保方案,是选民最为关心的问题。即美国人越发担心一旦医改法案在2014年正式实施,是否会进一步推高医疗费用。毕竟,相关数据显示,新医改将使美国未来增加5.68万亿美元财政赤字,在美国国债余额已达14.3万亿美元下,这将意味着美国企业和居民今后将需缴更多税费,以填补新医改增加的财政缺口。

  坦白说,美国的医疗体系是世界上最贵的,其每年的卫生总费用占GDP的17%,约2.4万亿美元,其中政府卫生支出占总卫生支出的46.2%;同时普华永道研究所认为,不必要的诊疗服务费和价格欺诈占据全美医疗费用额的一半,即1.2万亿美元。而这源自美国医疗市场日益突出的柠檬化现象,即由于目前美国实行的是自愿而非强制性医保制度,保险公司基于自利考虑而不愿为65岁以下年长者和体弱多病者保险,而年轻人或身体健康者则因保费较高等而不愿参保,从而加剧美国医保市场的柠檬化效应。

  奥巴马的新医改之所以遭遇到强有力的反对,原因之一是,尽管美国有3200万无医保的人群,但这些没医保的人不是穷人和老人,而是那些既达不到救济又没有足够收入的人,以及一些认为自己不会生病,医保费用高不愿缴纳的人群。

  原因之二是,新医改尽管执行强制医保制度,旨在遏制保险公司不愿为体质差者保险,及强制年轻人投保,同时对保险公司的保费进行审查,但新医改很难有效缓解美国医保市场的柠檬化问题。如新医改虽要求保险公司不得拒绝体质差者入保,但这将使商业保险公司通过拖延审批等手段,增加体质差者的参保难度,并采取各种优惠措施吸引年轻人参保,以致使大量体质差者购买政府的医疗保险,而商业保险公司吸收大量年轻人参保。显然,这将使医疗费用支出主要为政府承担,进而不仅反过来推高医保费用,而且将推高政府财政赤字,从而引发美国人对新医改会增加其医疗费用之担忧。

  美国医保费用的持续上升,增加了美国企业和居民的医保成本和负担。可以预见,今年美国大选中,不论是奥巴马连任还是罗姆尼获胜,都需通过实施医疗改革措施,抑或修改新医改法案,以降低日益攀升的医疗成本。
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