If you believe some accounts of a new Commonwealth Fund study, everything is awesome in American health care. According to the LA Times, a new report by the private health care foundation finds for the first time since it started measuring these outcomes that Americans are seeing improvements in access to health care and fewer cost crises:
The new Commonwealth survey indicates that the new insurance options are probably lightening the healthcare burden on millions of others. From 2012 to 2014, the percentage of Americans who did not visit a doctor or clinic despite having a medical problem in the previous 12 months fell to 23% from 29%.The percentage who did not fill a prescription fell to 19% from 27%. And the percentage who did not get needed specialist care declined to 13% from 20%.There were similar declines in stress from paying for healthcare; the share of Americans who reported problems paying medical bills in the previous 12 months dropped to 23% from 30%.
It is refreshing to see a foundation drill down on the access question, when so much health care rhetoric makes a misleading equation between being “insured” and having access to care. These are the kind of “on-the-ground” realities we need to be measuring.But the LA Times story quotes significant caveats: according to the Commonwealth Fund, the growth of high deductible plans could reverse some of these trends and access problems still remain acute for lower-income Americans. And even those may not be caveats enough, given that Gallup’s study of the access question reached the opposite conclusion. According to that poll, “Despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure.”When it comes to the financial portion of the Commonwealth survey as well, other metrics paint a bleaker picture of employers passing on more health care costs to their employees, out-of-pocket costs growing, and medical debt on the rise. It may be that Commonwealth is right and that Gallup is wrong—the Commonwealth survey does have a larger sample size—but reaching that conclusion would require a careful attempt to sort though the different studies and their methodologies. Instead, we’ll probably see ACA supporters enthusiastically latch on to the Commonwealth study as evidence that the law is working, even though the caveats that the foundation itself endorses are sufficient cause for concern. But so the health care debate goes.