Health care costs to surpass total income?

Take a close look at the chart up above. It’s taken from a new paper, in the Annals of Family Medicine. If you believe the doctors who put it together, it tells one of the scariest stories you’ll ever hear.

The gentle upward slope represents the median income for an American family, projected through 2035. The lighter colored curve is projected average spending on health care - insurance premiums, and out of pocket costs.

With current trends, the authors say, in less than 20 years the average family will face medical costs that are higher than their total income. All of it.

Dr. Jennifer DeVoe, one of the authors, says she already sees the strain in her practice at the Oregon Health Sciences University in Portland.

“I see people who don’t eat, or don’t pay rent, so they can pay medical bills,” she says. “They can’t afford their medication, or in some cases, even a mammogram.”

The basic facts aren’t new. Health care costs have been growing faster than inflation since the government began to track them in the 1960s. Between 2000 and 2009, the paper says, the average annual increase in insurance premiums was 8%, while household income rose an average of 2.1%.

But some experts say the doom and gloom is overblown. J.D. Kleinke, who last month wrote a Wall Street Journal op-ed titled “The Myth of Runaway Spending,” points out that growth in health spending has been moving closer to the overall inflation rate, for the past decade.  He says the slowdown came because insurers and private companies introduced plans with higher deductibles and bigger co-pays at the same time the government introduced health savings accounts, where individuals can get a tax break to help pay for medical expenses.

“In the old days, people never questioned cost because they were basically given a blank check,” says Kleinke. “Industry figured it out and said, 'This is madness.' ”

DeVoe acknowledges the trend, but says what strikes her first, “is that these costs are still increasing.”

Whether you see health spending as a crisis, depends, in part, on your focus.

In 2009 and 2010, total spending on health care grew at a slower rate – 3.8% and 3.9%, respectively – than at any time on record. But even that outstripped inflation –  1.6% in 2010, and a negative 0.3% the year before.

At the same time, a larger share of the cost is being borne by individual families. According to a survey last year by the Kaiser Family Foundation, premiums for family health insurance plans rose 9%.

To Kleinke, a resident fellow at the American Enterprise Institute, shifting the burden is good and necessary.

“Because people feel the economic pain directly, they’ve actually changed behavior, and spending did start to come down.”

A wild card in all this is the Affordable Care Act, often called “Obamacare.” Critics say expanding health insurance to cover another 30 million people will send costs through the roof. But ACA supporters point to provisions meant to slow or reverse the growth in spending - especially an emphasis on preventive care, which is supposed to reduce the need for expensive hospitalizations and emergency room visits.

DeVoe says the ACA is a “great first step, but it’s not enough to get us where we need to go in terms of sustainability.”

Co-author Dr. Richard Young, who runs the country’s largest family practice training program, at John Peter Smith Hospital in Fort Worth, Texas, points out that the new federal “comparative effectiveness” program - meant to compare the benefits of different treatments - is explicitly forbidden from considering cost, just as Medicare is forbidden from denying any “medically necessary” treatment, no matter how high the cost, or how small the medical benefit.

Young put it bluntly in an interview: “Until we’re willing to say 'no' to somebody, anybody, there is nothing to stop this inflationary pressure.”

Asked if the analysis isn’t deeply pessimistic, he said: “That’s right.”