"Secondly, we point out that the cost of care is really for chronic illness among those under age 65, whereas most of the political attention has been paid to those over 65 in Medicare, which is not surprising since the government share of the payment is about 43% of the total," he says.
Also, most wage earners who glance at their pay stubs each week would be surprised to learn that the individual's share of his health insurance coverage—both in government and commercial plans—has actually declined from 23% of the cost in 1980 to 11% in 2011.
"The consumer has lost a great deal of the say in the debate over healthcare by virtue of the fact that the individual is not directly purchasing care," Moses says. "Public opinion polls have shown consistently since the 1990s that though patients trust their physicians they are progressively less likely to trust insurance companies or hospital systems. That trend has only accelerated since 2010 and the Affordable Care Act."
"At some level, patients realize that the system is very badly broken in the sense that they have an indirect say, costs are not clear, [and] prices are not transparent," Moses says. "That is all the more important because prices have driven the increases we have seen over the past decade. The patient therefore has in large measure been marginalized in this process. In our view that is what is behind the politicization of healthcare. First, healthcare is a surrogate for all the other problems of the country, but secondly patients have been disenfranchised in the process."