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Health Care Costs: Enough To Make You Sick!

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Martin P. Sellers
March 3, 2023


Costs of health care are high and getting higher. Much of the excessive cost of health care results from the complicated and disassembled health care system we continue to maintain as well as the fact that payers and providers are not monitored for pricing or cost decisions using competitive or analytical data. Half of all Americans have difficulty affording health care. These are not only homeless people but are those who respond to surveys given in the workplace. Older adults cannot afford the care they need due to high costs of Medicare program obtained medicine and doctors. In addition, prescriptions that are often not obtained as costs of drugs are outrageous. Uninsured adults, particularly those in minority groups, account for a higher share of those who cannot afford health care. Those covered by health insurance cannot pay co-pays or meet deductibles. Many Americans, when asked their worst fear, indicate the fear that they or their children will get sick and they will not be able to pay the cost of health care. Public administration is losing the battle in the field of health care.


Health care costs are out of control in the United States, and for those who have no control over the social determinants of health such as housing, transportation, jobs, social connections, information, the internet, obtaining health care and resulting costs are beyond their means. Individuals put off important medical tests or the purchasing of medications because of the cost. Most uninsured adults under the age of sixty-five have postponed obtaining health care due to costs. More than half of working adults who are insured say they postponed health care due to high costs of copayments and the growing cost of insurance deductibles. Individuals assigned a medication regimen often end up taking half doses or no doses. Outpacing worries about their health, older adults are worried about how to pay for health care as Medicare has upfront costs (paid from social security checks) that many cannot afford.

Complicated Morass

As an instructor of Public Administration (and a health care consumer), it remains shocking to me that we allow the health care system to be so complicated and out of control. To boil it down (somewhat), there are three groups of payers: 1) government through CMS—Medicaid and Medicare, 2) commercial insurance companies and (3) self-payers. And there are two groups of health care providers, 1) hospitals and (2) providers such as clinics and doctors. On the payers side, government agencies have no control over costs. The Centers for Medicare and Medicaid Services (CMS) determine the least cost for all possible services in a region, and then miraculously determine reimbursement rates. Removing a growth on the face, for example, is not payable, nor is a new knee for someone who cannot walk (or work any longer). Medicare recipients must pay a substantial portion of their social security to visit a doctor or obtain medications. That portion is greater, the lower the social security check. Most elect not to do so and so go untreated. The second group, commercial insurance payers, determine their payment schedules based on data available which includes uncontrollable salaries, expense and supply costs. On top of that, hospitals arrange agreements with insurance companies to add non-paid CMS expenses so that the insurance company will add them into a network. Networks are also a curious operative in that individuals and families who have work-related insurance are never quite sure if their doctor or hospital is in network or out of network or if they need to switch networks during open enrollment.


A significant difficulty is that a substantial portion of U.S. citizens have no health insurance or means for obtaining health care. “In 2021, roughly 30 million people did not have health insurance in the U.S. This number includes all age groups, but nonelderly adults have the highest uninsured rate.” This is so even in the face of the Affordable Care Act.  Hence, 9 percent of U.S. citizens receive no health care. It has been ingrained in most of us that health care (good health) supports employees ability to work. Lower costs occur when medical treatment is obtained when needed. For those who pay their own way or have commercial insurance, copayments are an obstacle. Generally, a $25 co-pay may not seem like much, but when there is no food on the table or when school fees need to be paid, choices are exceedingly difficult. Deductible payments are just that: payments made in cash by persons seeking health care that must be paid before insurance will pay its part. Deductible costs for a family can be too high to pay, often in the thousands of dollars.


Most Americans either cannot afford health care or choose to limit the care they seek, due to costs. The complicated morass of how health care prices are determined and how care is paid is far too complex to support good decision making by individuals or the public administration of health care.

Author:  Dr. Martin P. Sellers is Dean of the School of Arts, Humanities, and Social Sciences at Lincoln Memorial University in Harrogate, Tennessee. The MPA program at LMU is fully online. Before academics, Sellers worked for city, county, state, and national governments, including a stint with the US Department of Agriculture. [email protected] and @martysellers.

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