As more people opt out of insurance, they may delay preventative care and rely on expensive emergency rooms when issues become critical. This uncompensated care inadvertently increases costs across the system, a problem the Affordable Care Act aimed to solve.
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In the US, where public health is not a political priority, the catalyst for policy change promoting healthier living will be fiscal. The government cannot afford the current trajectory of healthcare spending, which will eventually force changes in housing, food, and community planning.
Rising premiums and deductibles are pushing people away from traditional insurance. This isn't an abandonment of healthcare, but a market response to a product that no longer provides adequate value, forcing a shift towards cash-pay and alternative models.
The rise of cash-pay proactive health creates a two-tier system. One group can afford to defect from insurance and build their own health stack, while another cycles through the traditional system, relying on charity care, exacerbating inequity.
General Catalyst's CEO highlights a core flaw in healthcare: insurance providers don't reimburse for longevity or preventative care because customers frequently switch plans, preventing insurers from capturing long-term ROI. The first company to solve this misalignment and make longevity "financeable" will unlock a massive market.
While federal law mandates hospitals treat all emergency patients, financial strain's real impact on patient access is the elimination of less profitable but essential services. Hospitals are cutting rural labor and delivery units, pediatric specialties, and psychiatric services, rather than turning patients away from the ER.
Widespread cancellation of medical debt, while well-intentioned, may remove consumer pressure on providers. If patients don't need to shop around or question prices because they anticipate forgiveness, it eliminates a key market force needed to control escalating costs.
The expiration of enhanced Affordable Care Act subsidies threatens 24 million members with "sticker shock" from average premium increases of 25-30%. This looming financial crisis for individuals is a key pressure point in the government shutdown negotiations, especially with open enrollment starting.
For individuals with a multi-million dollar net worth, forgoing expensive health insurance can be a rational financial choice. The substantial savings on premiums (e.g., $300-400k over a decade) can create a fund large enough to cover most medical costs out-of-pocket, effectively creating a self-insurance pool.
As pharma companies build direct-to-consumer (DTC) channels for high-demand drugs, large employers see an alternative. This could motivate them to drop insurance coverage, shifting costs to individuals and paradoxically reducing overall access despite the new DTC option.
Government subsidies within healthcare systems like the ACA create a perverse incentive for providers and insurers to inflate prices. This triggers a toxic flywheel: higher costs demand more subsidies, which in turn fuel further price hikes, making the underlying problem of affordability worse over time.
