There’s a reason, hiding in plain sight, contends Chad Terhune, a seasoned health care journalist. He wrote a revealing Op-Ed in the New York Times, pointing out that 1 in 9 Americans now works in health care, up from 1 in 12 in 2000. Look around the country: Hospitals are throwing up fancy new buildings and putting to work tens of millions, many in some seriously high-paying jobs. As Terhune has noted:
Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single biggest sector for job creation. Hiring rose even more as coverage expanded in 2014 under the health care law and new federal dollars flowed in. The law gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Mr. Trump last year.
In Rust Belt locales like Pittsburgh, Cleveland and St. Louis, health systems have become major employers, Terhune reports, and that’s true in exurban spots like Morgantown, W. Va., Fort Collins, Colo., and Danville, Pa. In Los Angeles, the University of Southern California is a top job source, mostly due to its enormous hospital system.
So are savvy politicians willing to poke in the nose one of their big and burgeoning constituencies? Terhune asks. Maybe not.
This is a huge problem because it removes a significant check-and-balance on the staggering inefficiencies in the health system, which lumbers along with elephantine non-medical labor costs. The American medical system is rife with “legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills. For every doctor, there are 16 other health care workers. And half of those 16 are in administrative and other nonclinical roles,” Terhune finds.
He quotes Bob Kocher, now a venture capitalist and a former Obama Administration official: “I find super-expensive drugs annoying, and hospital market power is a big problem. But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”
Elisabeth Rosenthal, another excellent medical journalist, is getting deserved praise for her new book illuminating how sick medicine has become as a big business, perplexing patients and their families with an avalanche of bills and poorly explained services. The workers who make up the armies involved in medical billing also are costing doctors and hospitals more, as they must compete for their services, Terhune says.
Need more aggravation? He reports that 8 percent of U.S. health spending goes for administration, as compared with 3 percent internationally. In other words, there are plenty of fat cats making huge paydays as sultans of hospitals and health systems.
As the president and majority Republicans in Congress try to repeal and replace Obamacare, they’re attacking not only health coverage for the poor, old, children, chronically ill, and the disabled, they’re also slashing at key fundamentals considered by businesses that offer health insurance to their workers. Most Americans get their health coverage at work. If the ACA is repealed and replaced, especially as the Republicans wish, will employers’ insurers keep protecting employees with pre-existing conditions, and will older Americans be shielded from paying much higher premiums than the young?
In my practice, I see not only the harms inflicted on patients who seek medical services, I also see their painful struggles with soaring medical costs, and what is, in my view, unconscionable medical debt. As I’ve written, tens of millions of Americans are struggling mightily now as their companies, by encouraging high deductible policies with lower monthly premiums, have shifted the burdens of medical costs on to them while saving money for themselves. Partisan attacks on Obamacare aren’t helping these increasingly desperate Americans. They would be helped, as would we all, if medical costs would stop zooming ever upward. That’s going to be a mammoth challenge when so many of us work in health systems, and politicians and policy-makers lack the courage to question medical care bloat.