Blog | Thursday, December 6, 2018

Financial security of health care


With the midterm elections in the rear view mirror, and a divided government coming, there has been a lot of speculation that the most likely outcome would be a grinding stalemate in Washington. So I was surprised when I saw a headline in the New York Times last week that speculated that progress in Congress was still likely on a number of important personal finance issues. When I read past the headline, however, what really struck me was that so many of the issues they reported on were really not about personal finance, so much as about how the crazy state of health care in America is a financial nightmare for so many.

The authors cited six areas where Congress could still get its act together and pass meaningful reform despite the partisan rancor:
• better data on college graduate earnings,
• reasonable accommodations for pregnant workers,
• expanded tax breaks for paid family or medical leave,
• expansion of medical expense tax deductions,
• elimination of surprise medical bills, and
• curbs on black marks from medical debt.

Forget about the policy details for a minute and just look at the list. Five of the six items that need fixing are all about health care. More to the point, they are about how the current health care system leaves so many Americans one health crisis (or pregnancy!) away from financial ruination, and about the blindingly complex way that care is financed in the U.S.

People have to worry about accommodation for pregnancy or illness because we lack a national commitment to health. We need higher deductions for medical expenses because the expenses are so high that they cause widespread hardship. We need protection from surprise medical bills because there is too little transparency and too much complexity in health care coverage. And it is nothing less than a national stain that the most prevalent cause of personal bankruptcy is medical expense. We don't need fewer “black marks” on our credit ratings from medical debt, we need less medical debt.

This is a list that would make no sense to citizens of just about every other country with an advanced industrialized economy.

I think this list is just one more sign that we are on an unsustainable path, and—divided government or not—some serious reform of health care financing has to come soon.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of Northwell Health Physician Partners, and a professor of cardiology and professor of occupational medicine, epidemiology, and prevention at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is board certified in internal medicine and cardiovascular diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining Northwell Health. He is married with two daughters and enjoys cars, reading biographies, and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.