The United States is in the middle of a heated debate on healthcare reform, but for the time being, little has been enacted. Regardless of one’s position on the political spectrum, it is an undeniable fact that healthcare and health insurance costs are rising across the nation. Problematically, Americans often cannot keep up with these cost increases which leads to many people either foregoing healthcare, even though they may desperately need it, or going deep into debt after receiving care. Moreover, there is a growing group of American families that make slightly too much (401% or more of the American poverty level) to qualify for government subsidies who will be completely out of options for affordable healthcare in the upcoming years due to price increases. This impending threat to availability of coverage has been confirmed by a new study from eHealth Incorporated  in which they project that in 2018 “In 47 of 50 cities surveyed, the lowest-priced plan would be officially unaffordable under Affordable Care Act affordability standards for families earning 401% of the federal poverty level (about $82,000 per year in the contiguous US, making them ineligible for Obamacare subsidies).” Moreover, they calculate that “the average three-person household would need to earn an additional $28,939 per year before the lowest-cost plan becomes affordable.” These figures were based on a very conservative estimate of a 10% increase in healthcare premiums (most projections indicate a 20%+ increase).
It would seem that Congress and the current administration are shifting their focus to tax reform without considering many other available options for change in the healthcare industry. The GOP repeal efforts have largely been concerned with removing the individual mandate of the ACA and stopping government expansion of Medicaid/cutting existing programs, another key part of the Obama healthcare reforms. As a result of individuals facing loss of coverage, the Democrats have been staunchly opposed to any repeal and replace legislation. At a more fundamental level, the debate is about increasing government spending which is required to subsidize premiums and expand Medicaid as a whole. Centering the debate around a very limited number of government spending options has left more market-oriented reforms out of the spotlight. While some of them do alter government spending, the secondary effects of market and regulatory reforms include the lowering of the price of health insurance at the supply level, instead of trying to provide subsidies to keep up with the independent growing costs.
One excellent example of innovative market-oriented reform appears in a paper published in the Journal of the Association of American Medical Colleges in 2015. Joseph Antos, PhD  proposes that the government stop efforts to alter prices with regulations such as the age ratio limit (ratio that older members can be charged in proportion to younger members). This doesn’t effectively lower the cost of care for the elderly, insofar as companies can just increase prices on the younger members, as setting a price level doesn’t change the actual price of a service. Another method he proposes to improve consumer options and price levels in healthcare is increasing the amount of information available to consumers and healthcare providers. Important information comes in two forms, improved healthcare education in America which helps form healthy habits, and availability of data to tailor healthcare one receives to their exact needs. Engaging the public through improved health literacy promotes good consumer health habits and can decrease the need for expensive care in first place. Secondly, on the issue of data in healthcare Dr. Antos writes: “Information also fuels health care delivery. Electronic health records are the leading edge of the “big data” revolution.” That data being consolidated in medical records allows doctors to continuously specialize the treatment that patients get. While these approaches likely have flaws, the point is not necessarily to hastily pass untested healthcare reform. Rather, the debate needs to be shifted away from the usual mandate repeal and tax credits in search of some viable middle ground and meaningful reform.
Unfortunately, until something can be done to reduce costs of health insurance and healthcare itself, charities and individual communities have been left to ease the burden of those who fall deep into debt trying to take care of their health. Problematically, only a few such organizations exist. I founded the American Medical Debt Relief Foundation back in January of this year to confront this issue. We raise funds to purchase medical debt from third party collectors in conjunction with another organization called RIP Medical Debt. Even small donations can have a huge impact on the problem, as the debt can be bought for just pennies on the dollar. After the debt is purchased, we ensure that no one will ever try to collect on it again. This means that patients can focus on recovery instead of repayment. The website of RIP Medical Debt can be found at ripmedicaldebt.org