It only feels like we’re paying more for health care

Adapted from MedPAC, "Report to the Congress", March 2018; Note: CHIP was created in 1997, only included in 2016 share. Chart: Axios Visuals

Think you’re getting stuck with bigger bills for your routine medical costs, like copayments and deductibles? You might want to look at this chart, based on research from the Medicare Payment Advisory Commission. It shows that, back in 1976, our disco-dancing ancestors paid a way bigger share of own their health care costs than we do today.

Between the lines: If you’re wondering how that can be true, we’ve got some thoughts from Matthew Fiedler of the Brookings Institution, and the MedPAC report has some clues too. The basic answer is that health coverage has gotten more comprehensive than it was 40 years ago.

Yes, but: Out-of-pocket costs don’t include premiums, so it’s possible that we’re just paying for our health care in other ways.

The details:

  • Medicare drug coverage didn’t even exist before 2006, as Fiedler points out. More of the public is now covered through Medicare, Medicaid or CHIP, too.
  • There’s less data available about whether private health insurance has gotten more generous, but look at how much its share of personal health care spending grew. (There are also guardrails now that didn’t exist before the Affordable Care Act, like annual and lifetime out-of-pocket limits.)
  • Over the last decade, the share of costs we pay out of pocket hasn’t changed much. But, Fiedler points out, the dollar amount has, because prices keep rising.
  • The number of people in high-deductible plans has risen, Fiedler notes, so we’re more likely to pay out of pocket earlier than we used to.
  • We’re also not getting paid as much — salary and wage growth have been trimmed so our employers can keep giving us health insurance.

The bottom line: We pay for health care in so many different ways — some hidden, some not — that you’re probably not going to feel much relief even though public and private health coverage has gotten better.