I really do not understand the malaise that grips most Americans about voting in mid-term elections…I really don’t. My interest in the election on November 4 was as intense as when I first voted in 1968 and in every election held thereafter. Elections are the only venues and the most exciting social engagement parties to which all citizens are invited. And, arguably, participating in elections beats acts of civil unrest as the preferred way to influence government performance.
What I don’t like about elections today, though, is what I do very much like about weather reports. Meteorologists now get their weather predictions right almost always, and, much to my dismay, so do the analysts who predict the outcomes of elections. Because they do, much of the sizzle that elections generate for true public policy junkies like me is eviscerated. I am consoled, though, by the promise that the new and enhanced prediction analytics hold for improving the quality of health care we deliver.
But the subject is elections, and the one we just had was not a complete yawner for me. I was fixated on Proposition 45, the statewide ballot initiative that proposed to rein in health insurance rate increases by subjecting them to a review and approval process by our state insurance commissioner, much like what the passage of Proposition 103 in 1988 did for auto insurance. It was rejected decisively –a near 20-point margin– by California voters. A clear victory for the industry, to be sure. However, the defeat of Proposition 45 leaves us searching for ways to tame health care cost inflation, which promises to cripple our local, state and national economies if not dealt with affirmatively and aggressively.
Over the last decade, the average annual health insurance premium paid by employers rose by 113 percent, and the consumer contribution increased by 131 percent. Moreover, health care spending is projected to grow 1.1 percentage points per year faster than the average overall growth of our economy through 2023, resulting in a 2.1 percentage point expansion of health care’s share of our gross domestic product—from 17.2 percent in 2012 to 19.3 percent in 2023. And that’s with the features and benefits of the federal Affordable Care Act factored in.
Proposition 45 may not have been the answer –and this commentary is not intended to side with either its proponents or opponents– but the problem it addressed unequivocally looms large. In the interim, we should expect more cuts in government payments to providers and more costs shifted to consumers.