A rough ride ahead for healthcare

I felt a slight shiver come over me when I renewed our private health insurance 

Healthcare in the US is bracing for some seismic changes in 2025. Of course, the biggest disruptor is President Trump taking office this month, but there are others. The killing of United Healthcare CEO Brian Thompson will also continue to echo around the halls of health.

The widespread reaction to Thompson’s death was rooted in the greed that permeates the American health system. Some on social media celebrated, while others condemned the killing, but understood the perceived motive: To strike out at someone representing a system that has failed them. Brian Thompson became the personification of a broken system.

Writing in STAT, Elliott Fisher, Professor of Health Policy, Medicine, and Community and Family Medicine at the Dartmouth Institute and the Geisel School of Medicine, saw the reaction as indicative of the level of suffering associated with health issues in the US.

“The vast majority of Americans say that healthcare is unaffordable or that they fear bankruptcy if they need care,” he wrote. He added that many who work in healthcare do so because they want to help others, but now they are experiencing a moral injury that comes with not being able to do so.

The Americans spend twice as much as other nations on health and get worse results. And these costs have a broader impact. Businessman Warren Buffett has referred to healthcare costs in the US as the “tapeworm of American competitiveness”.

It’s not just the costs of healthcare. What really hurts are the intrusive and sometimes arbitrary ‘cost-containment’ practices such as pre-authorisation of treatments and even the post hoc denial of promised payments by health insurers. Healthcare has become big business in the US – could the same happen in Ireland?

I felt a slight shiver come over me when I renewed our private health insurance at the end of 2024. I have been with the same health insurance company for the last five years, during which time there was a not unexpected increase in premia year-on-year. But these increases were never more than single digit percentage hikes. However, when I received my annual renewal notice I was shocked to see a 26 per cent fee increase for my wife and I to retain the same level of cover. The company wanted us to pay an additional €900 for 2025 to maintain our current plan.

So, it was time to do some research. Did you know there are some 350 different plans offered by our three established health insurers? And have you, as a medical professional, tried to find one that meets your needs?

Well, good luck. Even with a clear idea of what our needs were, I found it extraordinarily time-consuming to figure out.

A feature in the small print was a reminder of how US-style health insurance could be creeping up on us. If you are of a certain age, you know that a hip or knee replacement is something you need to be insured against. And claims for joint replacement must be increasing rapidly because the insurance companies have suddenly introduced an 80 per cent cap on the pay-out they offer in all but the most expensive insurance plans.

For a hip replacement, that cap will mean an additional bill of €4,000 over and above your insurance premium. That will hardly threaten bankruptcy for most of us, but watch out: It’s the beginning of a trend that could, if it continues, hit hard in the future.

But back to the US. Donald Trump’s decisive election as US President in November puts many aspects of health and science in a deeply concerning position. Even before the Thompson killing, Trump’s imminent return to the White House had left much of the US health community shrouded in uncertainty and fear. And his appointment of Robert F Kennedy Jr as the next US health and social services secretary is anything but an anxiolytic.

The black sheep of the Kennedy clan has made many misleading health claims. He has taken aim at the Food and Drug Administration, the Centres for Disease Control and Prevention, and the National Institutes of Health, with veiled threats of their dismemberment.

“This is a time for more science, not less, and for the value of science to be defended and promoted,” wrote the editor of The Lancet in a commentary on Trump’s election.

Time to strap in for the rough ride ahead.