The giant firms that track trends for big businesses have glum news for all of us: Health care costs are spiking anew this year. The rise, one consultancy predicts, will be the highest in 13 years.

All the usual suspects are at fault here: Hospitals, doctors, insurers, and Big Pharma. Our country is now projected to spend more than $4 trillion annually — just under 20% of the gross national product — on health care. Americans far outspend their peers in industrial nations on health care — and they — we! — have poorer health outcomes.

While major challenges with the affordability of medical care have hit regular folks’ budgets hard already, the issues have not yet commanded the attention comparable, say, to consumers’ struggles to deal with inflation and pay for items like eggs, fuel, housing, and home and auto insurance.

Health care merited scant mention in the 2024 presidential campaign. What do to about it is yet another deeply divisive partisan issue. Michael Cannon, the director of health policy studies at the libertarian Cato Institute, told the New York Times:

“Republicans think they can ignore health care. They can’t. Democrats think they have solved health care. They haven’t.”

When some treated the killer of a health insurance executive on the streets of Manhattan as a folk hero and paid money to defend him, many were rightly staggered. That crime also surfaced the fury that many patients feel about the U.S. medical system and its crushing costs.

But what should patients and their loved ones watch for and do in the days ahead to deal with medical costs and the cascading problems they cause?

It doesn’t matter where consumers get their coverage. They’re all going up: Plans sold to private employers, on public exchanges via Obamacare, or government program like Medicare.

Employer-provided coverage is expected to cost 5% to 9% more this year, while patients obtaining policies under the Affordable Care Act (ACA) will rise 7%. The standard Medicare Part B premium rose 5.9% and the program deductible increased 7.1%.

With most Americans getting health coverage through their employers, the forecast premium increases are familiar — and demoralizing, especially when considered in dollars rather than percentages, as a human resources group reported, quoting the consultants at Aon:

“The average cost of employer-sponsored health care coverage in the U.S. is expected to [surpass] $16,000 per employee, according to an analysis from Aon. That’s significantly higher than the 6.4% increase in health care budgets that employers experienced from 2023 to 2024, with an average cost of $14,823 per employee after cost-saving strategies. Employers bore the brunt of the expense in 2024, paying $11,956 versus the $2,867 average that employees paid, according to Aon’s analysis …”

As others have pointed out, the average annual cost of employer-provided coverage for a typical family — exceeding $25,000 annually —would buy a reasonable used car. And the increasing cost of health coverage affects companies’ bottom lines, with published research finding this:

“[Our study] suggests that increasing health insurance premium costs are likely associated with decreased earnings and increased income inequality, including by race and ethnicity, among U.S. families receiving employer-sponsored health insurance and are meaningfully associated with wage stagnation …Costs of employer-sponsored health care benefits have increased faster than workers’ wages for several decades, with important implications for disparities in earnings and wage stagnation.”

WHAT TO WATCH FOR: The new administration in Washington has narrow margins in Congress and leaders with scant or no experience in running sprawling health agencies with giant effects on individual and public health. Still, as unpredictable as the course will be in the days ahead, will the politicians and policy makers, for example, extend or eliminate federal assistance that made health coverage more accessible under the ACA for millions of Americans? Will they target Medicaid and slash health coverage for the poor, disabled, mentally disabled, and children — especially in the name of renewing tax cuts for the wealthy few and rich corporations? Will those in control in Washington push Medicare further into private insurer hands, favoring “advantage” plans, even as those work less and less well for patients? (The new Medicare czar, Dr. Mehmet Oz, hawked Medicare Advantage plans through his TV show, with few viewers knowing that he got a piece of their action.)

WHAT TO DO: Consumers must keep on top of their medical charges and coverages of them. Insurers try more and more to deny claims, doing so in hundreds of millions of instances (!). Fight back. Learn how to appeal denials, and then do it: this goes in patients’ favor more often than they might expect. Individuals and families have rolled over for a while now, accepting higher deductibles and lower premiums. This has meant too many folks in need forgo medical care because they cannot afford the out-of-pocket costs. Patients can work more with primary care doctors to manage their medical needs, thereby averting costly emergency services or unneeded and pricey visits to specialists. They can get many timely issues resolved with their primary doctor. For instance, it’s better to call a doctor who knows you and see her on a Thursday than to let a condition worsen and race to an ER late on a Saturday night. They may find their hospitals run urgent care centers that can treat with reasonable outcomes and lower costs (than an ER) many of the accidents and illnesses that affect growing kids.

Tracking medical expenses and what gets covered can help consumers in another important way: It can help them determine how they might benefit later in the year during open enrollment periods during which they also can decide on health savings plans. These allow those fortunate enough to do so to set aside sums ahead of time that can pay for eligible medical goods and services. They can have tax advantages. These plans have restrictions and it is important to read the fine print and discuss with your company HR experts, accountant, or lawyer.

The current administration, just to remind, failed in its last go-round to repeal and replace Obamacare, which it pledged to do. The current president repeatedly promised to provide patients with a “wonderful, beautiful” health care plan superior to the ACA. That never happened. Consumer advocates did warn patients against “skinny” health plans, including those offered by certain religious and social groups. Those plans promised lower premiums but failed to deliver much, if anything, in coverage when patients most needed it.

Patients are learning that the spending for hospital and doctor care will see an increase of +/- 5% this year. Sounds kind of moderate, doesn’t it?

Not when examined in context. As university researchers have found:

“Hospital service prices surged more than 220% between 2000 and 2022, according to a report from Rice University’s Baker Institute for Public Policy. While hospitals attribute rising prices to increased operating costs — particularly due to labor shortages from the pandemic — evidence shows that hospital prices have consistently risen faster than other medical services since 2006, according to the authors. This surge in prices has outpaced other medical services (130%) and overall inflation (74.4%), according to the report.”

The researchers separately reported that surging hospital costs — contrary to what many consumers may think — likely played a bigger role than rising health insurance expenses in powering the soaring cost of U.S. medical care.

As for costs for the services of doctors and other medical specialists, the experts see this ahead as they look at data that comes in slowly from recent times:

“Spending for physician and clinical services is expected to have increased by 8.4% in 2023 (and to have totaled $959.1 billion) compared with growth of 2.7% in 2022. Underlying this trend are expected accelerations in physician and clinical services spending growth for private health insurance and Medicare; for these two major payers, such spending is projected to have increased 8.8% and 8.6% in 2023, up from 4.6% and 6.8% in 2022, respectively …For 2025–26, spending growth for physician and clinical services is expected to remain stable and to average 4.8% …”

These high-level figures don’t explain the overwhelming financial effects of the rising costs of medical care in this country. Instead, tack on the percentage increases and consider context, like the average hospital stay is 5.9 days and pulls an average of $17,488 out of the pocket of a patient and her loved ones. Patients who undergo more complicated procedures in hospitals can get stuck with big charges, like $170,000 for a heart valve replacement or $40,000 for a hip replacement. Insurance often covers big bills, but woe to those who are under-insured or lack coverage.

With unchecked prices for hospitals and medical services, medical debt and bankruptcies savage significant numbers of regular folks in this country, especially those who suffer from costly, chronic conditions like cancer and heart disease.

WHAT TO WATCH FOR: The exact path for congressional budget crafters, as mentioned, is unpredictable — at best. But Republicans in the House already have fired up the opposition with their plans for whale-sized legislation that would attempt to force through partisan policy priorities, as envisioned by the White House. This includes finding more than hundreds of billions in cuts to government-supported health care programs — mostly, as mentioned, those affecting Medicaid. Proponents want to put in force this budget plan in part with draconian requirements to compel those who are old, sick, handicapped, and disabled to work in some way for benefits. Hospitals, doctors, and patient advocates argue that such cuts would not only slash at their finances, especially for already struggling providers in rural and ex-urban areas. It would over-burden the medical system with even more sick patients who don’t seek care until they need emergency treatments that are costly and poorly compensated for providers.

WHAT TO DO: Patients can work with employer programs and primary care doctors to deal with medical conditions, early and, with chronic conditions, with sustained management plans. The object is to improve patients’ health and reduce the need for hospitalization, pricey emergency care, and expensive treatment by specialists. Patients also can skip being passive about the cost of their care. They can ask, politely but firmly, if doctors can provide explanations about and appropriate options for expensive tests, treatments, and prescription medications. Patients also can take a huge cue from recent federal regulation requiring hospitals to provide greater detail about their charges. This has turned into a data morass for even expert researchers. But the takeaway from the major price differences that studies already have found in hospital charges is clear: With such giant variances, the prices are negotiable. Patients must scrutinize their medical billings, looking out for errors, redundancies, and gross overcharges. Fight these, in writing and polite, insistent calls and visits. Providers also may show a willingness to reduce rates if patients offer to pay cash, in advance, or with negotiated charges that avoid insurers and a raft of middlemen that have sprung up like invasive weeds. Patients also should not be shy about asking hospitals and doctors if they qualify for programs to assist the poor and working poor.

Early every year, Big Pharma jacks up the prices on hundreds of prescription drugs, and these increases — especially the average — get dutifully reported.

The price spikes have run around 10% annually, though the industry, apparently wary of a new administration coming to power, managed to keep the 2025 hike to 4%.

Consumers can’t rest easy with this apparent easing — for several reasons. First, there’s no magic to the timing of drug makers’ price increases for products that federal regulators have approved for U.S. markets. Makers can boost and reset prices throughout the year, pretty much as they please. Second, what happens with drug prices overall matters less to patients than what happens to the costs for specific medications they need.

And Big Pharma knows it hits financial bonanzas these days with treatments targeting at least two big areas of care: cancer and diabetes-weight loss.

Drug makers increasingly market drugs for serious illnesses with sky-high prices, causing in cancer care what specialists call “financial toxicity” for ill patients. The regulatory channels also have plentiful approval applications for new cancer drugs that don’t differ markedly from what’s already available — and they, too, carry steep prices.

Consumers, of course, cannot miss the avalanche of attention paid to prescription drugs targeted to diabetes care and that produce significant weight loss. Drugs like Ozempic and Wegovy have created billions of dollars in profits, so much so that the market value of Novo Nordisk exceeds the gross domestic product of Denmark, its home country. Patients struggle to keep forking out as much as $1,000 a month to lose significant amount of weights and keep it off — to the benefit of their care for not only diabetes but also heart disease and potentially other health conditions. Employers, insurers, and government regulators confront tough choices as to whether pricey weight-loss drugs should be covered and paid for. These are decisions that could cost companies, insurers, and taxpayers tens of billions of dollars.

Because Americans have become such a pill-popping people, the high cost of prescription drugs — which is much higher than is charged elsewhere in the world —rips through the medical system. Drug prices crush patients, who too often forgo expensive prescriptions — sometimes with lethal results. High drug prices boost the cost of hospital care, insurance coverage, and what taxpayers must pay in programs like Medicare and Medicaid. An attempt to rein in Big Pharma’s rampant profit-maximizing, instead, created a medical middle-man morass with pharmacy benefit managers. The PBMs blew up, and consolidated into giant concerns themselves, as they capitalized on their power to sway costs and influence which drugs get prescribed. They have been assailed by patients, businesses, regulators, and lawmakers. A House oversight committee investigating this murky bureaucracy and practices of PBMs found they neither improved medical care nor reduced costs, instead: “[P]atients are seeing significantly higher costs with fewer choices and worse care.”

WHAT TO WATCH FOR: The current president, in his first campaign and early in his first term, assailed Big Pharma on prices and other practices, then soon after met with its top executives. The White House accomplished little in the next four years on prescription drug issues. Will there be drug-cost cutting initiatives anew from the current administration? Both the president and his new Health and Human Services chief have criticized weight-loss drugs and anti-depressants.

Will the new administration reverse its predecessors’ policy plan to have Medicare cover costly weight-loss meds? Will the new administration reverse its predecessors’ fledgling program to allow Medicare officials to negotiate the costs of a handful and expanding number of prescription medications — a move advocates say will save taxpayers big money and help to drive down some of the most costly drugs’ costs to all? Will the current administration maintain their predecessors’ caps on the once-soaring cost of insulin, as well as a $2,000-a-year limit on out-of-pocket prescription drug costs for Medicare recipients?

WHAT TO DO: It’s a serious problem for older adults but it affects all patients these days: Doctors over-prescribe, and too many regular folks are spending money needlessly on prescription drugs they don’t need and can harm them. Patients should talk regularly with their doctors and pharmacists to review all the meds and supplements they are taking —and to eliminate as many as possible and ensure they are taking the right dosage now. Most of us can save money by skipping most vitamins and supplements unless a doctor orders them. Patients should talk to their doctors and get explanations they understand about all the drugs prescribed for them — what are they supposed to treat, how will they know they are working, can and when can they be stopped, what side effects do they have and which should be most concerning. Do not be shy about asking about medications’ costs and options, notably if there are cheaper, effective generics rather than expensive brand drugs. Even the best drugs do not work if they are not taken as prescribed. Please be sure you understand any drug prescriptions and adhere to them. This is a big problem in medical care. By the way, don’t keep prescriptions you no longer need because children and others might be harmed if they get into them and misuse them. Discard them with care — at your pharmacy, perhaps, and certainly not by tossing them in the trash or flushing them down the sink or toilet.

As everyone in this country grapples with the soaring cost of medical care, two big trends are adding to the harms: industry consolidation and whopping investment by private equity concerns, aka hedge funds.

Both these factors, research shows, increases patient costs, while decreasing their options and the quality of their medical care.

Here is how the excellent Center for Justice and Democracy at the New York Law School describes the detrimental effects of private equity (PE) firms pouring investments into medical care:

“In the mid-2000s, PE firms began setting their sights on health care companies, buying physician practices, clinics, hospitals, nursing homes, hospices, and other health care facilities. The consequences have been devastating. As one U.S. senator recently described it, ‘From facility closures to compromised care, it’s now a familiar story: private equity buys out a hospital, saddles it with debt, and then reduces operating costs by cutting services and staff – all while investors pocket millions. Before the dust settles, the private equity firm sells and leaves town, leaving communities to pick up the pieces.’”

PE firms are not the only enterprises pushing medicine into bigness, purportedly to see the benefits of economies of scale. Hospitals, in particular, are consolidating, with chains grabbing up facilities nearby and farther, growing ever larger and larger. As KFF (the independent, nonpartisan Kaiser Family Foundation) has reported, more than half of all hospitals and doctor practices are now part of large health systems.

The common kind of consolidation — with systems gobbling up hospitals, doctor practices, and other medical care facilities — leads to less competition, higher costs, fewer patient options, and poorer care, researchers for the RAND Corp. think tank found.

The Justice Center — which also has blown up too-prevalent myths about medical malpractice in its annual briefing book — reports that studies show that PE firms put profits over patient care, increasing harms as facilities and practitioners take shortcuts to meet tough financial goals set by new MBA-driven owners. Patients also get short-shrifted if they suffer injury because they likely have been forced to sign arbitration agreements that slash at their ability to have their cases considered in the civil justice system. They also struggle to pierce complex ownership structures to determine who might be legally accountable for harms.

Lawmakers in Washington, D.C., have expressed increasing anger and willingness to act against problems caused by health care consolidation and private equity investment. It is unclear what actions might occur with a new administration in charge in Washington, D.C.

Our aging population plays a huge role in the relentless spiking cost of U.S. medical care.

Experts know that an estimated 10,000 baby boomers each day reach age 65, and this trend will keep up for several more years. As folks age, their health tends to decline and medical spending spikes as they become old and very old.

Compared with our peers in other affluent, industrialized nations, Americans — especially our older population — are sicker and struggling to obtain and afford the medical care they need.

Chronic conditions afflict far too many in this nation, with the prevalence of cancer, heart disease, diabetes, obesity, and high blood pressure increasing as people age. An estimated 129 million Americans have at least one condition, studies show. They also find that just under half of us (42%) have two chronic conditions and 12% of Americans have five or more (!).

Studies show that preventive steps — like eating more healthfully, exercising, sleeping better, reducing stress, avoiding smoking and excessive consumption of alcohol and other intoxicants — could put more Americans in better shape. But too many of us eat too much junk food, lead sedentary, pressure-filled lives, and use booze, cigarettes, grass and other drugs in harmful ways.

When patients need treatment, they enter a medical system that relies on armies of people — whether doctors and other specialists or those who cook for, clean up after, and assist the ill. The coronavirus pandemic injected a new financial reality into the country’s treatment of vital workers, especially in the medical system.

Now the system finds itself chasing after talent, paying higher wages and other compensation, and battling both inflationary pressures and the competition for skilled and unskilled labor. The Mercer consulting firm reports this:

“[Our firm] projects a nationwide health care worker shortage of 100,000 by 2028. Even before Covid-19, the U.S. health care labor market faced challenges with the demand for professionals in health care occupations outpacing supply. [The firm’s research] highlights how factors such as accelerated resignations, burnout among health care workers, an aging population and wages that lag the broader labor market are contributing to the decline in labor supply in certain states, particularly for primary care physicians, advanced practice providers, and nurses.