Cost Control First, Access Second

A new graphic published in the Journal of the American Medical Association underscores just how fast workers’ health care costs have been rising relative to their wages. The charts show, among other things, that the cost of health care premiums to employees has gone up about five times as fast as wages since 1999, and deductibles have risen almost seven times as fast as wages since 2010.

This grim picture suggests that the Affordable Care Act, with its focus on coverage expansion rather than cost control, came at things from the wrong end. In the long run, affordability is access, and attacking the factors that inflate the cost of health care in the U.S. will do more good for more people than trying to subsidize an ever-growing share of the population as health care costs continue to escalate.Moreover, stabilizing health care costs for the middle class could be more politically savvy for reformers. If the money currently being sucked out of middle class families’ budgets by escalating health care costs (including foregone raises they would otherwise have received) were in their pockets instead, they would likely be more willing to make sacrifices to help expand access for the poor.Politics is not just about building technocratic systems of income redistribution and social nudging. If Americans come to believe that intellectual and political elites no longer see the prosperity of the American middle class as Job One, they will grow to mistrust government, tune out wonkish discourse, and rely on their own base instincts—as indeed we are seeing now with the rise of Donald Trump.