Last week we lost Uwe Reinhardt, the famous health economist at Princeton University, his passionate voice and memorable sense of humor. Reading articles and posts remembering Uwe, a German who fled Europe during WWII for Canada, who was best known not only for his outstanding analyses of thorny healthcare questions but for his reminder to all of us that there are people behind the numbers. And, to the extent that our health policies and practices lead to outcomes that are unfair, he constantly pushed for solutions to make healthcare access more equitable.
Less than two weeks before Uwe passed away, Dave Johnson and Zeke Emanuel published a Viewpoint in JAMA called Measuring the Burden of Health Care Costs on US Families: The Affordability Index, which, at its core, raises fundamental questions about the fairness of a healthcare system that continues to take a bigger and bigger chunk out of middle class incomes.
Even before this article was publicly available, Uwe read it and provided both a compliment and a challenge in an editorial comment on JAMA. He praised Dave and Zeke for proposing a measure that is “compact and easy to calculate”, calling it “a welcome new potential tool in the armamentarium of health statistics.” As a macroeconomic measure, the trend line displayed by graphing the Affordability Index makes the unmistakable point that the cost of an employer-sponsored health insurance policy now represents almost 31% of the average American family’s income, up from only 14% in 1999.
However, pushing us all to go further to demystify this statistic, Uwe asks “What does that number [31%] really mean?” In other words, what microeconomic measure can we produce and make accessible that will resonate with American consumers and help derail the impact the runaway train of healthcare costs is indeed having on families?
In fact, he proposed that we use data from the annual Medical Expenditure Panel Survey (MEPS) and related data sources to create a user-friendly interactive tool for the media and the general public to make this information widely available and understandable. He concludes by saying, “…such a data system could help constrain the folklore on which health policy so often is conducted and provide to legislators robust data about the fragile US health insurance system over which they preside.”
We totally agree with Uwe. On the same day JAMA published Dave and Zeke’s article, 4sight Health published a companion Market Corner Commentary, “Introducing the Affordability Index: High-Cost Private Health Insurance Reduces Family Incomes” in which we also call for regular publication of the Affordability Index to draw public attention to the heavy price Americans pay for healthcare coverage.
To Uwe, the health economist who in 2003 said “It’s the Prices, Stupid!” about why healthcare costs outrageously more in the United States than in other countries, we would like to say thank you for making us recognize the power of consumable information to change our healthcare system for the better.
In his view of the world, a better healthcare system is one that is inexpensive and equitable and we must continue to strive for such a system in our country. Thank you, Uwe, for reminding us to always ask, “What does our system say about our values?” After all, it is compassion for the people behind the numbers that must guide us