Here is an example of the kind of consolidation that has to be stopped if we are to rein in excessive costs in the US health system. Kaiser is planning to buy a large hospital system in North Carolina, further combining the health plan/provider model, but also further limiting competition.
It is useful to understand past components of health spending from multiple perspectives, but it is even more important to examine where that spending is heading in the future. Health spending is a huge percent of the US economy--over 18% of GDP. Every year the Office of the Actuary at the Centers for Medicare and Medicaid Services, which oversees the Medicare program and federal aspects of Medicaid, releases its analysis of spending in the past year and projects future spending. (OA Report) Health spending grew 7.5% in 2023 compared to 2022. National health expenditures were $4.46 trillion in 2022, $4.8 trillion in 2023 and is projected to be $5.04 trillion in 2024 and $7.7 trillion in 2032. Personal health care expenditures, which is the health care we all receive, was $3.7 trillion in 2022, $4.04 trillion in 2023, and is projected to be $4.25 trillion in 2024 and $6.53 trillion in 2032. On a per capita basis was $11,200 in 2022, $12,140 in 2023 and is projected to be $12,700 in 2024 and $18,600 in 2032. Bet you didn't know that much was being spent on your health care!! Of personal health care spending in 2023, private health insurance spent $1.43 trillion, Medicare $1.02 trillion, and Medicaid $852 billion. For 2032, projections are that private health insurance will spend $2.22 trillion, Medicare $1.94 trillion and Medicaid $1.33 trillion. On a per employee basis, for 2023 private health insurance spent $6838 per person, Medicare $15,689 and Medicaid $9336. For 2032 the comparable figures are projected to be $10,576 for private insurance, $24,921 for Medicare and $15,632 for Medicaid. Private insurance spends less because the covered population is younger and it is managed better. Looking at those projections for Medicare and Medicaid spending, you can see why the federal budget is so stressed. 93% of the population had some health coverage in 2023, that is projected to drop to 90.7% by 2032, largely because the epidemic Medicaid expansion is being reversed. In 2023, about 210 million Americans had coverage through private health plans; 65 million through Medicare and 91 million through Medicaid. In 2032, as the population ages, the same number are projected to be covered by private insurance, 77 million by Medicare and 85 million by Medicaid. The Medicaid numbers are ludicrous, Medicaid was supposed to cover a few people unable to work, not old enough for Medicare and without another source of health insurance. As people never tire of pointing out, our health spending is far higher per capita than that in other advanced economies. But that comparison ignores health lifestyle issues, like obesity and drug and alcohol abuse, that are far more prevalent in the US. And most of that difference is due to higher prices in the US, not excessive utilization.There are constant releases of relevant economic data on the US economy. I try to sort out the most important and give summaries for readers who want to understand what might be happening. And there is a lot conflicting data. Last week there was a very good 30 year Treasury bond auction, smaller in size than the shorter term debt issuance, which helps the sale. Today, there was an outstanding 20 year Treasury bond auction, with a lower than expected interest rate on the final bid and excellent coverage in terms of amount of bids versus amount to be sold. But it was a small auction, only $13 billion. I am sure that a significantly larger auction, of the size similar to the 3 year auctions, for example, would encounter more difficulties. I am puzzled to some extent by the Treasury’s strategy, focusing on selling massive amounts of new and rollover short term debt, which right now tends to have high rates and which will need to be replaced in the relative near term. The Treasury seems to be praying that somehow the Federal Reserve or some other mechanism will lower rates substantially. I don’t see how that can happen given the supply needs. (ZH Post)
And the supply will be simply unprecedently enormous given the ongoing deficits. Another release this week was the Congressional Budget Office’s update of the federal deficit for the current fiscal year, which ends in October. (why we don’t use the calendar year for the federal government is a mystery, but it likely helps keep the public befuddled about our financial state). The report finds that Bidementia is actually running a $2 trillion federal deficit this year, up 27% from the CBO estimate just in February. Here’s how you get a deficit that big–you collect $324 billion in taxes in May, but you spend $670 billion. Yes, you read that right, the federal government spent twice as much as it collected in May. And don’t think it is because taxes are only paid in April–withholding and estimated taxes are due all year long. The deficit just for May is $100 billion more than expected. I remember when $100 billion was a huge deficit for a year. (CBO Report)
Worse yet, the CBO projects that deficits over the next ten years will be over $22 trillion. That means total debt would be over $50 trillion. That is unthinkable and unsustainable. Interest payments would be over half of all federal expenses. The spending has to stop now. We need to eliminate all the insane “green” and “renewable energy” subsidies and spending, except for grid improvement. That will save trillions. Then we need serious reform of all the programs that have millions of slackers getting free food, free health care, free housing, and so on. That will save trillions more. A courageous Congress could balance the budget next year and stop piling on debt and interest costs.
And the real economy is suffering more than appears to be the case in “official” statistics like the job numbers put our by the BLS or any number of other garbage data releases by Bidementia. We are in deep, deep shit and drastic action has to be taken now.
Okay to some extent this is a puff piece put out by a group supported by those who offer Medicare Advantage plans, but the data is real. Medicare Advantage now covers over half of all beneficiaries. The plans generally have better benefits at a lower cost, so have been attractive particularly to lower income persons. In addition, over the last few decades most adults have had some form of health plan coverage from their employer, so continuing to be in one for Medicare does not feel like a big change. Congress and CMS have been intently reviewing the program, particularly in regard to payment, which likely will result in downward adjustments, and enrollment growth will slow just because of the size of the MA population. CMS and Congress are going to have to make a decision soon about what to do with traditional Medicare, which is essentially unmanaged and has poorer quality outcomes than MA. A number of MA-lite initiatives have been launched in recent years including accountable care organizations, but they don’t have the same results. The right thing to do is put every beneficiary in an MA plan, with an out-of-network option similar to traditional Medicare today.
In any event, the report focuses on the relative out-of-pocket spending by those in traditional Medicare versus MA enrollees. The average MA member paid a little over $2500 less out of pocket than did a fee-for-service Medicare beneficiary, or around 40%. Since MA members are on average lower-income, this is particularly meaningful for them. And the gap in out-of-pocket spending has grown in recent years. The results are true for both dual-eligible beneficiaries (those with Medicare and Medicaid) or Medicare-only. The same level of savings is present when accounting for MA plan premium portion paid by beneficiaries and comparing to persons who have a Medicare Supplement. (MA Report)