“Ryan’s American Health Care Act is fatally flawed: It does nothing to address the high and rising cost of chronic illness.
Although discussions about health care often involve talk about uncertainty and risk, the reality is that a large share of medical costs are predictable. Consider the million-plus people in the United States with rheumatoid arthritis. RA, as it is known, is an autoimmune disease. It is much less common than its more prevalent namesake, osteoarthritis, but the symptoms are every bit as bad: pain, stiffness, swelling and loss of function in affected joints. There is no cure for RA, but treatment can reduce pain and improve functioning. The drugs of choice cost $10,000 to $30,000 annually (most are still patent-protected), with prices rising at double-digit rates. Not surprisingly, the cost of treating RA is soaring. More than $100 of the premium paid by every enrollee in the Affordable Care Act’s exchanges goes toward treatment of inflammatory disease, including RA and related conditions.
Health care is a series of RAs: severe illnesses that are expensive and unsurprising. Eighty-four percent of medical spending is for the 50 percent of people with at least one chronic disease; half of spending is for the 16 percent with three or more chronic conditions. People with chronic diseases know they will have them forever; those without have a low chance of contracting one in any year. Nearly half of people who are in the top 10 percent of spending in one year are in the top 10 percent the next year.
The central question for health policy is who should pay for the predictably expensive. Healthy people may be asked to pay more than their own situations warrant — through higher insurance premiums, taxes for Medicare and Medicaid, or markups on the drugs and services they receive. Doctors, hospitals and pharmaceutical companies may be asked to shoulder costs through lower payments. Or the chronically ill themselves may be asked to pay what they can — and to go without care they can’t afford.
Democrats and Republicans agree that we should do everything we can to reduce the prevalence of chronic illness. But beyond that, financing health care involves difficult choices. The problem with the AHCA is that by pretending everyone can have everything, it avoids the need to grapple with persistently high costs. As any therapist can attest, avoiding trade-offs does not make them go away.
In the end, that evasion is what the CBO exposed, estimating that 24 million people would lose coverage under the GOP replacement plan in the next 10 years and millions more would face higher costs. The failure to address the persistently ill — a moral and economic failure — is the reason no amount of tinkering, regulation or subsequent legislation will ever fix what is wrong with Ryan’s plan.”
read full article at Washington Post