This time of year typically brings lots of “look back at the year” columns and lists, but since it is also the end of a decade, we are getting lots of “look back at the decade” as well. So what happened last decade in health care. National health spending moderated, but grew faster than either the economy or personal income. Out-of-pocket health spending, in the form of premiums or cost-sharing, continues to be a pain point for many Americans. Even if it isn’t growing as fast as it was, it is high in comparison to many people’s disposable income. The issue with health spending growth continues to be unit pricing, not utilization. In comparison to other developed countries, generally our drug prices are high, our medical device prices are high, what we pay doctors is high and what we pay hospitals is high. Want to cut spending and spending growth; you are going to have to cut unit prices. Provider consolidation is one factor supporting these high prices and provider consolidation went largely unchecked during the decade. Competition is basically non-existent in most of America.
The Affordable Care Act was in effect for most of the decade. Remember this law was promoted as a panacea that would cure the access, spending and quality ills. That was a lie then and the decade has shown what a lie it was. At a significant cost, a relatively small percent of Americans obtained health coverage that didn’t have it before. Until a recent repeal, the law attempted to make even people who really don’t need health insurance buy it, so they could be forced to contribute to the cost of health care for others. Providers’ lives were made miserable by a forced program of EHR and other IT use, and by never-ending “quality” reporting and improvement programs, most of which have been shown to do nothing. And while the law was sold as reducing premiums and costs; it has done nothing of the kind. But hey, since one government “reform” was a disaster, why not try another one, even more grandiose–Medicare for All! How about we dedicate the 20s to reducing government involvement in health care and see how that works.
There was some improvement in treatments for diseases. Cancer became an often chronic disease, thanks to new drugs that extended survival, although not usually curing the disease. There has been modest improvement in controlling some chronic diseases, but little improvement in getting people to engage in better health behaviors that would limit the number of patients with those conditions. There was unparalleled hype about digital health, mobile health, apps, wearables, big data, artificial intelligence, machine learning, population health, analytics (did I miss any buzz words), but no real sustained demonstration of value while adding a fair amount of cost. So pretty much another decade of high spending with not a lot of gain in actual health status of the population.