Below are the rates for my student health insurance coverage for the coming year.
I’m newly married, so my spouse and I will be enrolling together. That means that the total cost of health insurance for our family of two will be $7,522. Even though I’ve been paying $3,000 a year for my own insurance, $7,522 inspired some sticker shock. Our care is pretty heavily “managed” in this plan, allowing only three appointments per year outside of the University Health Services, so this seemed particularly expensive to me.
But the truth is that $7,522 for two people is probably below average. Health costs are rapidly approaching $20,000 a year for a family of four. In our case, though, we don’t yet have the benefit of an employer covering 60% of those costs:
That we find ourselves at the financial mercy of our healthcare system is a small irony since I am a part of that system. Knowing that average health care costs have doubled in the last nine years, I am worried about how much our insurance will cost next year. I have heard many prominent physicians say that it will fall on my generation of doctors to address this problem. So what does the future hold?
Some are hopeful. Atul Gawande’s Harvard Medical School graduation speech was about the potential that working in teams, like pit crews, has for improving health care and reducing costs. I agree with him. My friend and classmate Ian Metzler wrote on the The Health Care Blog recently about the need for education, improved clinical judgement, decision-support, institutional leadership and payment reform to help make care less expensive. He is also right.
But will all of this really “bend the cost curve?” What makes us think that these savings won’t simply lead to higher margins for providers, health systems or health insurers? Until we address the enormous cost of a private insurance system, either through stricter regulation of insurance premiums or through a public health insurance plan, we’ll have a limited impact on costs.
We also have a deep problem in our national consciousness. Too many of us, including myself before medical school, proceed with the notion that medicine should be able to fix anything and prolong our physical health indefinitely. We are willing to try obscure and expensive treatments with marginal benefit. As a society we have to accept the limits of what medicine can do. We need to come to better terms with our mortality and the inevitability of physical break-down and emotional loss.
For a long time, I wanted to believe that our problem with healthcare costs could be solved with technocratic expertise. But the fact is that our problem is deeply political and cultural. Young doctors need to realize this: working in teams like a pit crew is a start, but what we really need is to change the direction of the race.
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