"Dad, I got a bill for $1,113." One of our daughters was incensed. "I went to my doctor with a simple question. She sent me downstairs where they drew a few tubes of blood for tests. It took two minutes. How do I owe over $1,000?"
She's not the only one outraged by out-of-pocket health costs in the U.S. Many of us feel we are paying more for less and less insurance coverage. We blame high-deductible plans, rising co-pays and other policies that seem to shift more costs onto patients. Headlines such as "Out-of-pocket health spending in 2016 increased at the fastest rate in a decade" amplify the unhappiness.
But the perception of ever higher out-of-pocket health care costs obscures important facts.
It's true that, in 2016, those costs rose 3.9%. But health care costs overall increased 4.3%, so as a percentage of total health care spending, out-of-pocket costs actually fell. And this has been the case for several years. In 2010, total out-of-pocket costs amounted to almost $300 billion, 11.5% of national health expenditures. By 2016, they rose to slightly more than $350 billion, but fell to 10.6% of total spending.
What's going on? Well, a lot of people point to businesses shifting more workers into high-deductible health plans. Such plans save an employer, on average, more than $1,500 per insured family. In 2017, more than half of all insured American workers had health insurance with a deductible exceeding $1,000 – that's almost twice as many as had such policies when Obamacare passed. But that's not all that's changed.
