Who do presidential candidates blame for high health costs?


The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways.

So what it is about the system that politicians believe is to blame for the staggering cost of medical care in the United States? To get a sense, I asked a team of research assistants to scour presidential candidate speeches and websites, to see what or who they say is responsible for high health care costs. Our methodology was admittedly unscientific. We didn’t have access to every speech that each candidate made, for instance, or every television interview that each candidate conducted. And we made arbitrary judgments about which issues candidates mentioned versus which ones they emphasized, when they discussed health care costs. Those caveats aside, we got a pretty solid picture of how candidates, past and former, portray America’s health care costs problem.

Not surprisingly, these portrayals vary dramatically across party lines:

Who presidential candidates blame for health care costs


Here is what strikes me about this picture, in no particular order.

1. Wow, there used to be a lot of presidential candidates!

2. Republicans are universal in blaming Obamacare for high health care costs.

This blame is largely misguided. It is true that the Affordable Care Act (ACA) increases health care spending in several ways. It gives more people access to health insurance, which is known to drive up demand for health care services. In addition, it requires insurance companies to cover services that many used to leave uncovered, things like preventive colonoscopies that improve public health but that also cost money.

But Obamacare cannot hold the brunt of blame for high health care costs in the U.S. for the simple reason that those high costs long preceded the law. In fact, since the ACA became law, health care costs have risen more slowly than expected in the U.S. Much of this slowdown has nothing to do with the law. Spending has slowed because of the recession and because of the movement toward high-deductible health insurance plans, for example. But the ACA also created an innovation center within Medicare that has been experimenting with ways of bending the cost curve.

So love Obamacare or hate it, you should not blame it for the lion’s share of our health care spending problem.

3. Democrats largely blame pharmaceutical companies, insurers, and large corporations.

This, too, strikes me as way off the mark. Pharmaceutical companies, for example, cannot bear the majority of the blame for high health care expenditures because medications do not make up the majority of health care expenses. Pharmaceutical companies make an easy target for politicians, of course, because many Americans pay out-of-pocket for a significant portion of their drug costs. But is a drug company really to blame for charging legally allowed prices for its product? Why aren’t we blaming lawmakers who, on the one hand, require Medicare to pay for certain drugs while, on the other hand, giving the program no ability to negotiate prices (negotiations they, of course, have undermined by requiring Medicare to cover the drugs in the first place)?

As for insurance companies and large corporations? For the most part, these organizations have strong incentives to lower health care spending, not raise it. Do you think insurers enjoy paying the high price of, say, American hospital care? Do you think employers enjoy spending so much of their money on employee health care benefits? It simply doesn’t make sense to blame insurance companies and large corporations for high health care costs.

The U.S. health care system is insanely complex. There is lots of blame to go around for our staggeringly high health care expenditures. Hopefully, our presidential candidates will soon hone in on a better set of diagnoses for our spending problem, so we can get a better idea of what, if anything, they plan to do to cure what ails our health care system.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com


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