Analysis | Six Common Myths About Healthcare And Three Reasons Why People Believe Them

Healthcare is complicated, people are easily confused, and there are powerful motivations to believe many misconceptions. I was reminded of this at the last meeting of the industry-led group that is steering the state's efforts to control healthcare costs. But the problem isn't limited to industry representatives. Providers, administrators, patients, consumers, advocates, employers, and consultants paid to know better are also afflicted. It's natural to see the landscape from our own perspective, to only see what isn't working for us. But the problems cross the entire healthcare landscape. If Connecticut is going to make progress toward affordable healthcare that works for everyone, we have to look farther and deeper.

The most persistent myth is that lower Medicaid prices are driving up private insurance rates. It's worse than wrong. It's simple and short, so it's appealing. But it's just not true in healthcare. There is overwhelming evidence that when Medicare or Medicaid rates increase, large health systems don't lower commercial insurance prices – they spend the extra money on other things. Like most businesses, healthcare systems charge each customer as much as they can.

Another common misconception is that spending more on primary care will lower total healthcare costs. It's true that we should all get our recommended screens and checkups – it can save lives. And it's a short leap from that to thinking that pouring more money into primary care will lower healthcare costs. If done in a smart way, it may be the right thing to do. But there is strong evidence that it doesn't save money overall.

Some prevention does save money – childhood vaccines are a classic example. But some doesn't – such as screening people who aren't at risk for a disease is unlikely to help. In fact, it can cause more harm from the anxiety of false positives and the resulting unnecessary treatments. Primary care payment reforms and paying providers to screen and refer patients to community services like housing and healthy food don't improve health and they don't save money. But meaningful partnerships with community service providers work.

There is little evidence that increasing primary care payment rates improves access to care, quality, or reduces other more expensive care. Doing primary care smarter includes following the evidence, coordinating care, supporting primary care practice, and investing in technology that works.

Another classic is the myth that mandates, services that insurance plans must cover under state and federal law, are driving up healthcare prices. Mandates include services such as emergency care and cancer treatments, care that most people would expect health insurance to cover. The evidence is clear that sky-high prices for hospital care and prescription drugs are the main drivers of rising healthcare costs.

Another misconception, that employers pay all the costs of higher healthcare prices, isn't supported by the evidence. The majority of rising healthcare costs are shifted onto workers in less generous benefits and lost wages. According to new research, from 1988 to 2019 the average American family's income was five percent lower because of health insurance cost growth. Consumers and taxpayers know that we pay the bills.

I get this last one a lot – we just need more "common sense" to fix healthcare. Too many people underestimate how complex and counterintuitive healthcare is. The Law of Unintended Consequences is very strong in healthcare and the rules of common sense don't apply. Too often, people rely on their own experience as a provider, a patient, or an employer, but don't see other perspectives.

There are countless examples to counter the common sense myth. Bringing managed care organizations into Medicaid was a "common sense" disaster. Another was the idea that making the prices for healthcare services public across providers, would bring down costs. It doesn't work in healthcare. In some cases, it raised costs when providers learned they could charge more. If you want to understand healthcare better, CT Healthcare Explained can help.

The myths persist because our brains look for quick answers that make us feel better.

* Thinking is hard. Our brains have evolved cognitive biases to make it easier. But they can backfire. My favorite is that we tend to believe information that confirms what we already think. But there are many other biases that can lead to poor policymaking.

* People are experts on their own experience – their facility, their business, their or a family member's illness. Seeing things from others' perspectives takes work.

* Vested interests also spend a lot of time and money telling us only their side of an issue. Finding evidence for the other side takes work.

Every year I assign my students a debate on timely health policy questions. We hold a lottery to choose which side they will take; someone has to take the less popular position. No other assignment causes as much anxiety at the beginning, especially for students who have to argue the less popular, less intuitive position. But in the final class evaluations, most rate the debates as the best part of the class. Challenging your assumptions can be empowering.