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A KFF Health News article highlights how a rise in premiums (and loss of subsidies) have prompted people to delay medical care. The article focused on older Americans who might be a few years away from Medicare eligibility, but the rise in effective premiums is quite alarming: "his monthly Obamacare insurance premium payment tripled this year to $2,460, about a third of his income." As another example, "her monthly premium payments more than doubled, from roughly $1,100 to $2,333, for a plan with a $10,150 out-of-pocket maximum."

While subsidies provide some short-term relief, they do not address the underlying growth in medical costs. Subsidies might actually give providers less incentive to reduce costs, as they mask the cost (which eventually show up in higher premiums) to patients. Subsidies might make sense as a short-term policy, but ultimately, the underlying cost trend needs to be addressed.

KFF Health News outlined the struggles of some primary care physicians: "primary care providers take on more clinical responsibilities, and for less pay, than most medical specialists." The lower salaries (relative to other specialties) has contributed to a shortage of primary care physicians. However, the article also points out that "primary care providers need time and money to manage or prevent illness ... and their insurance reimbursement rates should take that into account," meaning that declining or even stagnant reimbursement rates from insurance companies can have an outsized impact on primary care providers. The article also highlights why many of primary care physicians are keen to retain their independence, rather than, say, work at a large hospital system or for a practice owned by private equity.

One way that some primary care doctors have reacted is to adopt a business model known as "direct primary care," which "bypasses insurance altogether" (and is therefore less accessible to the average patient). However, some other doctors are banding together in what are known as independent physician associations (IPAs), which gives the doctors "power in numbers when negotiating contracts with Medicaid, Medicare, and private insurance companies." IPAs can also be reimbursed for value-based care where "the medical practice is given a budgeted amount for each patient's care, which provides an incentive to keep them healthy so they need fewer treatments. ... If there is money left at the end of the year, it's split between the practice and the insurer." Many people in the industry have hopes that valued-based care will help slow the growth in healthcare costs.

The general sentiment from large medical associations seemed to be that as long as patients visited properly credentialed physicians, the patients would essentially not have anything to worry about beyond the standard risks. In the world of plastic surgery, however, it appears that botched surgeries have become so prevalent that even the "The American Society of Plastic Surgeons, which represents 12,000 doctors, is now warning patients to 'do their homework'," as reported by KFF Health News.

Although patients are entitled to lodge formal complaints to the state licensing boards, one member of such a board points out how "the disciplinary process is rigged in favor of doctors, mostly because of the power of medical groups in the state lobbying to thwart change." One tangible recommendation is that boards "should alert the public about doctors under investigation for alleged misconduct." As it stands, "complaints to medical boards about surgeons or other doctors can remain under wraps for years." While publishing allegations can have some negative consequences, not doing so and taking years to investigate the complaints seems to pose too great of a patient safety risk.

Insurers like to portray themselves as gatekeepers who help prevent runaway prices for medical procedures. After all, if they pay less for medical procedures, their costs are less, which theoretically should mean more profit. In this model, the insurers and patients are aligned in wanting low prices at clinics and hospitals.

KFF Health News published a piece explaining that the incentives that insurers face might actually tilt the other way. After providing examples of seemingly outrageous prices, the article explains that "Insurers aren't incentivized to lower prices, because high prices mean they 'get a slice of a bigger pie'... when prices rise, they can pass on the increase to customers in the form of higher premium costs... [which] mean less money for the patient and more profit for the insurer." The article notes that "Medical inflation has steadily outpaced general inflation for years, with bills for many brief, routine procedures reaching tens of thousands of dollars." Patients are affected by the high prices because even with insurance, they often need to pay the deductible or co-insurance, which can amount to several thousands of dollars.

KFF Health News highlighted a Family Connects program in New Orleans, where the city offers mothers of newborns free home visits by nurses. "The nurses arrive with diaper bags filled with newborn essentials, from diapers to nipple cream. They weigh, measure, and examine the babies, and check in with the mothers about their health and well-being. They offer referrals to other programs across the city." As background, "Louisiana is among the worst-performing states in maternal and infant health outcomes," giving officials strong motivation to try a different approach. Research based on the Family Connects programs in other communities show promise: reduced trips to the emergency room, earlier diagnosis of postpartum depression, and cost savings ("Research on North Carolina's program found that every $1 invested in the program saved $3.17 in health care billing before the child turned 2.").

This intervention seems like a positive policy development, in which an early investment yields better patient health and fewer costs later on. This idea has been the premise for other programs as well, but the results do not always fulfill the initial goals.