Navigating America’s Health Care Woes: A Call for True Payment Reform

Let’s talk about the current troubles people run into when receiving health care in the U.S. The hassle of making an appointment, switching doctors, getting piles of bills, and managing individual specialists who don’t work together to ensure you’re being taken care of in every aspect of your health. All of this can be time consuming, financially draining, and frustrating, but there’s a bigger issue lurking — a health care system that pulls on our wallets, without improving our health outcomes.  

Health care, including cost, access to a range of doctors and specialists, medications, and more, is top of mind at every check-up and routine visit and talked about outside of hospitals by families at the dinner table. People from all walks of life are calling for change, asking for real solutions that focus on making care affordable, easy to get, and top-notch quality. Let’s talk about how to answer those calls.  

The System Is Not Working for Us 

Health care spending in the U.S. is much higher than in other developed countries, with more than double the amount spent per person.¹ But the results? Not up to par. According to data from the West Health-Gallup 2022 Healthcare in America Report, 75% of people rate U.S. health care affordability as poor and one in five report that they have had a health problem worsen after being unable to pay for needed care. These issues have the greatest impact on women and communities of color.² Further, for the first time in two decades of study, Gallup reports that a slight majority of Americans rate health care quality as subpar, with 31% giving it a rate of “fair” and 21%, a record high, calling it “poor.”³

So why are Americans paying premium prices for not-so-easy access, low-quality, care? Under fee-for-service, the predominant way we pay for health care in the U.S., patients are charged for each individual service they receive at a doctor’s office or hospital.⁴ This means that providers are incentivized to make money by doing more high-cost procedures, like surgeries and tests. Meanwhile, providers receive no monetary benefit, are paid too little or not at all, for many important services like sitting down with patients to talk through a diagnosis, or taking the time to coordinate their care with other medical providers.⁵ To put it simply, our health care system does not always support or incentivize the care that is best for a patient which can lead to higher costs and poor health outcomes.  

Understanding the Depths of Health Care Needs

Laura B. is a research scientist in Minnesota who was finally diagnosed with an autoimmune condition after a series of unexplained symptoms left her fatigued and sick for weeks without a pinpointable cause. For three years, Laura was herded through the medical system from doctor to doctor and specialist to specialist, racking up medical debt, fighting insurance for prescription drugs approvals, and more, all to improve her quality of life. Her four children had to watch their mother go from incredibly active to barely able to get out of bed, and she had to give up her dream job to take a different position that allowed her to continue working and manage her health full time.  

On top of Laura’s job, coordinating doctor’s appointments, children’s activities and coaching soccer, managing her budget is a consistent struggle: “sometimes I am faced with the question of, do I buy food for my kids, do I get gas in the car, or do I take my medication? There are times when I don’t take my medication, because I have to feed my kids, and I have to get to work… I am a research scientist, I am in the field I want to be in, I don’t want to stop working.” Despite having a name for her condition(s) now, Laura often feels like she is treated by the health care system as “just a number.” 

When we say health is a kitchen table matter, we don’t mean that people in America should have to skip the doctor to afford to put food on the table. Yet, like Laura, nearly half of the American families face this dilemma due to high medical costs.⁶  

Getting timely health care is tough, too. Complex insurance and limited provider access are regularly standing in the way.⁷ Rural areas and communities of color face more barriers and even if individuals do manage to find a provider, navigating the system can still feel like an exercise in futility. 

Quality of care is another big concern. More than half of U.S. adults report high dissatisfaction with the quality of medical care they receive, and report that their most recent health experience was “not worth the cost.”⁸ Rates of preventable deaths, those that may be avoided by timely and effective care, are high, demonstrating a need for better care coordination.⁹  

In short, health care should be affordable, accessible, and high-quality for everyone, and yet, the current system falls short, especially for marginalized communities. We can no longer afford to wait for change. 

How Can We Tackle These Health Care Hassles? 

The current health care financing model sees people as dollar signs, not patients. That’s where policymakers come in — we need them to step up and make sure we’re treated like real people. Policymakers have a responsibility to address the consumers deepest health care needs through payment reform that incentivizes providing high-quality, accessible, affordable health care to all people. These changes can make a real difference right now and for generations to come.  

Policy Solutions in Action

The good news is: We’re moving in the right direction! Congress has taken important steps in recent years to crack down on industry abuses and anticompetitive behaviors that keep prices high and saddle consumers with the bills. The No Surprises Act is helping to tackle surprise medical bills, and the Inflation Reduction Act is letting Medicare negotiate for lower drug prices.^{10 11}  

Innovative programs like Primary Care First and efforts in Oregon and North Carolina are making strides in transforming the way we pay for and receive care, too.¹² But more reforms are needed to ensure the health of consumers is central in our system, including greater movement away from fee-for-service and toward a health care payment system that puts our health first.  

Now is the time for a movement led by us, the consumers; we want a payment system that’s all about us, where communities thrive, and people get healthier. There are so many people who have been willing to share their story on how payment reform can (and does!) make a difference in their health and quality of life.¹³ Imagine an America where everyone, no matter where they live or who they are, can easily get the quality health care they deserve without breaking the bank. Let’s make it happen together! 

To read a more in-depth analysis on this topic, check out our resource: Meeting Consumers Deepest Health Care Needs: A Call for True Payment Reform. 

Want to take an even deeper dive into meaningful health system transformation? View the recording of our recent webinar, a panel discussion on the principles outlined in our policy agenda. 

Footnotes:

^1. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/

^2. https://www.gallup.com/analytics/401972/healthcare-in-america-2022.aspx

^3. https://news.gallup.com/poll/468176/americans-sour-healthcare-quality.aspx

^4. Heather Lyu, Time Xu, Daniel Brotman et al., “Overtreatment in the United States,” PLOS ONE, September 6, 2017, available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181970#pone.0181970.ref001.Heather

^5. https://www.thirdway.org/report/the-case-against-fee-for-service-health-care

^6. https://www.commonwealthfund.org/publications/surveys/2023/nov/cost-not-getting-care-income-disparities-affordability-health

^7. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services</a”> 

^8. https://s8637.pcdn.co/wp-content/uploads/2021/12/2021-Healthcare-In-America_West-Health-and-Gallup.pdf

^9. https://www.healthsystemtracker.org/indicator/quality/mortality-amenable-healthcare/#Healthcare%20Quality%20and%20Access%20(HAQ)%20Index%20Rating,%202016

^10. https://www.cms.gov/nosurprises/

^11. https://www.irs.gov/inflation-reduction-act-of-2022

^12. https://www.cms.gov/priorities/innovation/innovation-models/primary-care-first-model-options

^13. https://familiesusa.org/resources/the-human-impact-of-payment-reform/