The cost of health care begins to afflict voters
By Raja Mishra, Globe Staff, 12/21/2003

For Glenn Crenshaw, $21 makes a difference.

That's how much the monthly medical bills for his 12-year-old son, Ryan, have increased this year. Even though Crenshaw, 42, has insurance for himself and his children, the slight bump in this one premium, on top of a series of health cost increases over the past five years, has quite literally caused him pain.

"I went without my arthritis medications for six months so I could pay for Ryan's pills," he said. "I was hurting all the time."

And though his older son plans to join the Marines this summer, health care costs, rather than terrorism or war, will be on his mind as he heads to the polls this election season.

"Health care will decide my vote," he said.

Crenshaw is far from alone. A poll for The Boston Globe, released this month, indicated that health care is the top issue for likely New Hampshire Democratic primary voters.

In a separate Kaiser Family Foundation survey, also released this month, 35 percent of respondents nationwide said rising cost was the year's key health issue, over health care for seniors, the uninsured, and HMO regulation.But while the Democratic presidential hopefuls have outlined various health-care proposals, specialists say that none has offered a plan that would effectively address the issue.

Their health-care platforms generally focus on insuring some of the 42 million Americans without coverage. This would help reduce some costs, given that hospitals and governments pass on to the insured the cost of caring for uninsured patients who show up in emergency rooms.

But specialists say covering more of the uninsured will not stem, in any significant way, rising health-care costs for others. Health care is more expensive because it has gotten better, and although Americans gripe about costs, they are also unwilling to forfeit the high-tech improvements that drive costs upward. That is why none of the major candidates is pushing for serious price controls or sweeping change of the sort required to tamp down costs, specialists say.

"While Americans don't like to pay a lot more, and they worry about rising costs, they are not amenable to things that restrict their access to care," said Diane Rowland, vice president of the Kaiser Family Foundation, a nonprofit group specializing in health-care research. "That's the dilemma of anyone trying to work on this issue." President Clinton was the last high-level Democrat to have pushed a plan that might have broadly reduced costs by moving many Americans into managed-care plans and by placing tight controls on many parts of the health-care system. That proposal went down in flames, and was among the reasons for a GOP landslide in the 1994 congressional elections.

The fact is that more money is buying better care. Computer scanners can give doctors detailed snapshots inside patients' bodies. Dozens of screening tests catch diseases early or detect problems that physicians once overlooked. An ever-growing arsenal of prescription drugs keeps a wide variety of maladies in check.

And it all costs money. For instance, from 1992 to 2001, Americans' prescription purchases increased 68 percent, from 7.3 to 11.1 prescriptions per person, according to a Kaiser study. In short, more people are taking more drugs. In that time, more than 1,000 new drugs were approved by the federal government.

"The technology is prolific," Rowland said.

In the 1990s, the health care industry pursued a way to try to control costs: managed care. But when Americans' care was managed, they reacted testily. Democrats led the charge as Congress threatened HMO regulation. In response, most managed care plans have loosened their controls over health spending. And costs have continued to spiral upward.

In Massachusetts over the past year, health insurance premiums rose 13.9 percent, the third consecutive annual double-digit increase, according to state data. In the same period, nonsupervisory wages went up only 3.1 percent.

Most people are covered through employers. But with costs rising, companies have taken more in wages to pay for the increasing prices. In Massachusetts over the past year, the average employee's monthly contribution for health coverage increased 61 percent, from $57 per month to $92, according to state data.

Health care is clearly eating away at wages. Many small businesses, unable to keep up with premiums, have stopped covering employees. Others who bought insurance on their own were priced out of the market.

Certainly, Glenn Crenshaw has felt these pressures.

The single father of four lives on "modest" disability pay, he said. His son Ryan has a congenital heart defect that can require more than $100 in prescription drug payments per month.

This year, the state government, which insures his son, raised his monthly premium to $52 from $31, citing budget pressures. Indeed, medical costs are the largest category of state expenditures, and have been steadily growing over the past years.

"I have a mortgage, I have three kids to support," he said. "On a fixed income, even $21 is a subsantial amount."

But Crenshaw benefits from developments in the pharmaceutical industry. Pills manage his son's heart-related problems, as well as his own peptic disease, chronic back pain, high blood pressure, and arthritis.

Indeed, pharmaceuticals have accounted for a substantial chunk of the cost increases. Drug spending in the United States has increased by 10 percent or more every year since 1995, according to the Center for Studying Health System Change.

Some assert that pharmaceutical companies are inflating prices to pay for their aggressive marketing practices. But it's widely agreed that drug development has afforded better care, from treating HIV to ulcers to high cholesterol.

But rising drug costs are not alone. In the first six months of this year, hospital inpatient bills in the United States rose 7.6 percent, hospital outpatient costs went up 12.9 percent, and prices for doctors' office visits jumped by 6.1 percent.

But there might be some relief ahead. Health care spending per American increased by 9.6 percent in 2002, down from 10 percent in 2001. It was the first time in five years that the cost increases slowed down, if only a little.

Raja Mishra can be reached at [email protected].