Guest editorial |

Guest editorial

Health care cost does not disappear, it merely shifts

Liana B. Teteberg, Founder and President Yarrow Hospice & Palliative Care

Perennially we debate and take firm positions on the issues of health care. The issues swirling about include the cost of health care, who should pay for health care and who should get health care.

None of these issues can be addressed individually without impacting all the issues. One way to look at health care in the U.S. is to imagine a very large balloon, containing all the stakeholders, such as the payers (public and private), the insurance industry, the population and the health care providers. When you press on one part of the balloon, it bulges on the other side and so forth. The size of the balloon varies little because when you decrease access to health care — by restricting adequate insurance coverage, for example, the cost of care for all who are uninsured is shifted to all who have the fortune to be insured as well as to those providing care. The providers, i.e., hospitals and others simply increase their rates to adjust for the losses.

The mortality rate of uninsured people in the United States is significantly higher than for those with adequate insurance. According to the Kaiser Foundation study in 2012, 130,000 Americans without health care insurance died between 2005 and 2010 because they had no access to care other than the emergency room. People without adequate insurance often do not receive health screens and preventive care and tend to delay or go without needed care until it becomes an emergency or they die. So, while those who are healthy (today) want access to adequate health insurance to be optional, the cost of the uninsured merely shifts the burden to others and becomes a hidden cost to society.

Illness, accidents, catastrophic events tend to come unannounced. A diagnosis of cancer can arrive at any age; trauma, even if relatively short lived, can deplete all resources and frequently results in bankruptcy. In fact, bankruptcy due to medical bills is near the top causes of bankruptcy according to several sources (

The very principle of insurance is based on large and broad participation, which allows the cost of insurance to be shared. If health care insurance is only taken by those who need ongoing care, the premiums would be out of reach for most people.

The issue of cost of health care is problematic. We insist on a “free market” approach to health/illness care — never mind that only the insurer and provider of care has any modicum of freedom. Providers are free to charge whatever they like and the private insurance companies are free to set the benefits and corresponding rates with few constraints. Medicare and Medicaid have been somewhat successful in what they will pay providers for their services and yet, the industry has found untold exceptions that allow additional payment.

Finally, there is no end to human “need” nor technology that can be employed to relieve suffering and extend life a little longer. Without a budget for health care, without defined benefits and without everyone’s participation — there is not now nor will there be a system that is fair to all citizens, the health care providers and contain the cost of health care in America.

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