Healthcare USA: American Exceptionalism Run Amok

U.S. consumers have a widespread appreciation that our healthcare system is overly expensive, but there is little understanding of who is being victimized by these high costs and how their burden is imposed. The frequent stories in the media about individuals being hit with outsized medical bills feature people of every age and from all walks of life. But the analysis developed here and documented with data shows that it is the working-age population covered by private insurance—including those covered by insurance from their employers, especially lower-earning workers—who are most burdened by the system's high costs. It also shows that most members of this group do not fully grasp the price they are paying for their health care, as a sizable share of the costs are imposed in the form of lower take-home pay. The combination of the high costs and their hidden nature has acted as a tremendous drag on workers' wages, leaving them less able to afford all the other things they need and want, such as educating their children, saving for retirement and buying a home. Our healthcare system is effectively a cancer on the American Dream. The analysis goes on to show how various segments of the health delivery system impose higher costs on the working-age population with private insurance than on those covered by Medicare, Medicaid and other public insurance plans. After presenting the evidence on whom and how the U.S. healthcare system exacts its high prices, the latter part of the analysis sets out alternative ways and policies that could reduce costs over time and lighten the disproportionate load imposed on workers and their dependents.

U.S. consumers have a widespread appreciation that our healthcare system is overly expensive, but there is little understanding of who is being victimized by these high costs and how their burden is imposed. The frequent stories in the media about individuals being hit with outsized medical bills feature people of every age and from all walks of life. But the analysis developed here and documented with data shows that it is the working-age population covered by private insurance—including those covered by insurance from their employers, especially lower-earning workers—who are most burdened by the system's high costs. It also shows that most members of this group do not fully grasp the price they are paying for their health care, as a sizable share of the costs are imposed in the form of lower take-home pay. The combination of the high costs and their hidden nature has acted as a tremendous drag on workers' wages, leaving them less able to afford all the other things they need and want, such as educating their children, saving for retirement and buying a home. Our healthcare system is effectively a cancer on the American Dream. The analysis goes on to show how various segments of the health delivery system impose higher costs on the working-age population with private insurance than on those covered by Medicare, Medicaid and other public insurance plans. After presenting the evidence on whom and how the U.S. healthcare system exacts its high prices, the latter part of the analysis sets out alternative ways and policies that could reduce costs over time and lighten the disproportionate load imposed on workers and their dependents. Reviews: "Uniquely among rich countries, most working Americans get their healthcare insurance through their employers. Syl Schieber has spent many years helping firms deal with these schemes and has seen the destruction and dysfunction that comes with this kind of American exceptionalism. This wise and sobering book should be read by everyone involved in healthcare and in healthcare policy."—Professor Angus Deaton, 2015 Nobel Laureate in Economics and coauthor of Deaths of Despair and the Future of Capitalism "In this punchily written book that deserves a wide readership, Syl Schieber pulls back the curtain on who actually pays the United States' extraordinarily high health care costs. The answer is not who many think." –Professor Joseph Newhouse. John D. MacArthur Professor of Health Policy and Management, and Director of the Division of Health Policy Research and Education, Harvard University "This volume is impressive in its use of data to document how and why the US health system is an economic burden for consumers. It is a rare and welcome work in the time it devotes to presenting a roadmap on a way forward to moderate its costs."—Dr. Adam Cifu, Professor of Medicine at the University of Chicago and co-author of Ending Medical Reversal: Improving Outcomes, Saving Lives "Schieber chronicles one of the largest and least understood sources of falling living standards among working- and middle-class Americans. With encyclopedic insider knowledge and deeply sober, nonpartisan judgment, he chronicles how failed policy, population aging, and unaccountable corporate power are combining to create a health care system whose direct and hidden expenses have become a cancer on the American Dream. His diagnosis is accurate, and his proposed cure is evidence-based."—Phillip Longman, Policy Director of the Open Markets Institute and former deputy assistant managing editor of U.S. News & World Report

Sylvester J. Schieber is an economist with nearly five decades of experience doing research, writing and consulting on health and retirement programs available to U.S. workers. After receiving a PhD, he began his career as a research analyst at the Social Security Administration in 1973 and had risen to be the deputy director of the Office of Policy Analysis by 1980. In January 1981, he became the first research director of the Employee Benefit Research Institute. In mid-1983, he was hired by one of the major U.S. human resources consulting firms to establish a Research and Information Center to track legislative, demographic and economic developments affecting employee-benefit programs offered by major employers for their workers. In the early 2000s, Schieber became the director of North American benefits consulting for the firm, then known as Watson Wyatt. He retired from the firm in late 2006 but has continued doing research, writing and consulting on health and retirement issues and has maintained an ongoing affiliation with senior researchers in the firm now known as Willis Towers Watson. Over the years, Schieber has consulted with some of the largest corporations in the United States on matters related to their workforce policies and the structure of the employee benefits programs they provide. Sylvester J. Schieber served as a member of the 1994-1996 Social Security Advisory Council appointed by the Clinton Administration. He was appointed to the U.S. Social Security Advisory Board in January 1998 and served on it through September 2009. He was appointed Chairman of the Social Security Advisory Board by President George W. Bush on October 1, 2006, and served in that role until departing the Board. Schieber has written extensively over the years, authoring a dozen books and more than 100 published articles. His book The Predictable Surprise: The Unraveling of the U.S. Retirement System, published by Oxford University Press in 2012, was awarded the 2012 TIAA-CREF Paul A. Samuelson Award for outstanding scholarly writing on lifelong financial security.