Health Cost Bottom Lines

Matt Yglesias makes a simple but very important point today about “health care costs” as understood by policy wonks and “health care costs” as understood by regular folk:

It’s easy to get confused about this because ordinary people seem to be very worried about the rising cost of health care. And wonks at the CBO also worry about health care cost growth. So when health care cost growth slows, shouldn’t people be happy? Nope. The cost people care about is the price that they personally pay. People care about premiums. People care about deductibles. People care about co-pays. What people do not care about is the underlying price trajectory of the service. Having the insurance company pick up 90 percent of the tab for a $1,000 procedure is way better than having the insurance company pick up 50 percent of the tab for a $500 procedure.

Why does this matter? Well, to the extent that conservatives tend to emphasize greater cost-sharing (a.k.a., “personal responsibility”) by consumers as a key strategy for health care cost containment generally, on the theory that over-utilization of health services is the basic problem, then they are running directly into the reality that “health care costs” for most Americans means how much it costs them. But it doesn’t just affect conservatives: if higher premiums, copays or deductibles coincide with the implementation of Obamacare, Obamacare is going to get the blame, no matter what’s going on under the surface:

Long story short, if Democrats stand up in a world of rising premiums and higher deductibles and say Obamacare is causing a slowdown in health care cost growth, people are going to look at them like they’re insane. Policy debates are one thing, but politicians who look at the clear blue sky and call it yellow are another.

There’s a lot of talk going on presently about the need to “educate” the public about Obamacare, which I agree with entirely. But it’s one thing to “educate” people about health care policies that don’t directly affect them, or that affect them positively if they take advantage of them. It’s another thing altogether to tell them that they should “rethink” policies that affect them negatively in the paychecks or their wallets. For the most part, they’re not going to believe it.

As Aretha would agree, health care policy is frustrating.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.