The Washington PostDemocracy Dies in Darkness

Opinion The state of our union’s health care won’t be fixed by Biden’s proposals

First lady Jill Biden reaches out to Joshua Davis, a 13-year-old diabetes patient who was a guest of the president at the State of the Union address March 1. (Evelyn Hockstein/Bloomberg News)

In his first State of the Union address, President Biden touted the temporary expanded subsidies for people receiving insurance via the Affordable Care Act. He reminded everyone that Americans pay more than people in any other country for prescription drugs, and demanded, once again, that Congress pass legislation allowing Medicare to negotiate their cost. Introducing a boy with Type 1 diabetes, he declared that Americans should have to pay no more than $35 a month for insulin. “Drug companies will still do very well,” he said.

All excellent actions, and observations. But the problem of out-of-control health-care costs is a lot more complicated than these fairly brief references in an hour-long speech. Americans are swamped — not simply by the high cost of pharmaceuticals but also by a costly, impenetrable and often all but unnavigable health-care bureaucracy that views them as just another source of funds.

The same day as Biden’s speech, the Consumer Financial Protection Bureau released a report showing medical debt is the leading cause of unpaid bills that get sent to collection agencies. This past year the Census Bureau reported that just shy of 20 percent of American households owed money for medical reasons. Recent surveys by health-care researchers at the Commonwealth Fund and, an online insurance comparison site, indicate that close to one-third of all U.S. adults have medical debt.

It’s all but impossible to keep up with the myriad ways things can go financially wrong for the patient in the American health-care system. Medical care, as I and others are forever pointing out, is rarely a planned-for expense that one can comparison-shop for in advance. For Americans with employer-based health insurance, the typical per-person deductible is in excess of $1,000 — a sum many families cannot afford. Co-pays multiply. Patients often receive multiple bills from different parties for the same event. Authorization for treatments can be denied not just before, but after the fact.

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In the endless quest to make someone come up with the money, the patient — the most powerless entity — is all too often the ultimate source. “When it comes to medical bills, Americans are often caught in a doom loop between their medical provider and the insurance company,” CFPB head Rohit Chopra said in prepared remarks released with the survey.

Miranda Yaver, an assistant professor of politics at Oberlin College whose field of study is, of all things, health insurance claim denials, recently ended up with a medical bill of more than $5,000 getting sent to collection, after an insurance premium payment went astray. And she’s an expert in all this.

Even the well-insured may spend significant sums of money out-of-pocket. Sarah Wald, a professor of environmental studies and English at the University of Oregon with metastatic breast cancer, told me she spent about $20,000 this past year on medical bills ranging from pharmaceutical co-pays to acupuncture to help her body handle the side effects of her medication.

Little wonder that, as covid-19 recedes, the issue of our unaffordable health-care bills is reemerging with a vengeance. A survey conducted by the Pew Research Center in January found it was second only to economic concerns as an issue voters said they wanted Biden and Congress to tackle this year.

If Biden is serious, he needs to take on not just Republicans but also his own party. Democratic pols — many flush with campaign donations from big pharma — have stepped in time and time again to stop systemic efforts to address the high cost of prescription meds, so much so that the Build Back Better legislation that got approved by the Democrat-controlled House (only to run into the solid roadblock of the split Senate) permitted Medicare to negotiate prices only for a handful of drugs.

It’s Sen. Joe Manchin III (D-W.Va.) who says we can’t afford to add dental care coverage to Medicare – something an all but overwhelming number of Americans want.

And it’s the Biden administration that’s allowing one of Donald Trump’s few achievements in the area of medical costs — a requirement that hospitals post all their negotiated prices with insurers and employers, as well as the cash price they offer up — to languish all but unenforced. A report released earlier this year by Patient Rights found only 14 percent of hospitals they surveyed were in full compliance with the law. (Conversely, the administration is enabling a Trump-era backdoor scheme to semi-privatize Medicare, one so sneaky that many patients enrolled in the initiative are unaware of it.)

Even if Biden got all of what he says he wants in the area of medical care in the United States, it won’t be enough. It will still leave all too many battling the high cost of necessary treatment. For individuals, it’s not just a financial burden. It’s often a matter of life or death. No wonder they consider tackling it such a high priority.