What kind of driver will your teenager be?

That has to be among the most important questions on the minds of young parents. Perhaps you believe if you’re a good driver, your teenager will be the same. That may be wishful thinking. How do you know? There are apps to track teen driving, but that information only tells you how well they did after the fact. What you really want to know is how well they’re going to do before they get out there on the road!

Relax! Someone who feels your pain is doing something about it. Julie Jargon, writing for The Wall Street Journal, says researchers at Children’s Hospital of Philadelphia built a virtual driving assessment—essentially a realistic car simulator—and found that it can accurately predict crash risk in newly licensed drivers. Why did a hospital do this? Because driving is one of the most important healthcare issues for teenagers.

Here are some statistics to make you nervous. Drivers between the ages of 15 and 20 made up just 5% of all licensed U.S. drivers in 2021, but accounted for 8.4% of fatal traffic crashes, according to the National Highway Traffic Safety Administration. The Centers for Disease Control and Prevention identified vehicle crashes as the leading cause of deathfor U.S. teens.

The researchers aren’t keeping the test to themselves. They have brought the tests to doctor’s offices in Pennsylvania and parts of New Jersey and Connecticut, as well as to traffic courts in Ohio. They are also seeking funding to offer them to teens in other states as part of their routine medical checkups.

How does it work?

To take the test, a teen sits at a desk with a driving wheel, brake pedal and gas pedal, all attached to a laptop running assessment software. “Grand Theft Auto” it isn’t, but it does have a realistic feel.

The 15-minute test is a simulated drive through a city where teens encounter pedestrian-filled crosswalks, railroad crossings and other potentially dangerous scenarios. Exposing them to possible crashes is a good way to see how they respond to real-life road crises, say researchers. Eye-tracking software analyzes where teens are looking while they drive down the virtual streets.

Peyton Leverich, a 15-year-old in Lansdowne, Pa., took the virtual driving assessment at her church in November. Turns out, she drives too fast on straightaways. She also needs to pay more attention to the speed and distance of oncoming cars when she’s making left turns. “It felt very realistic. Lots of people were crossing the street and there were school zones where you had to drive slower,” says Peyton, who plans to take driving lessons before trying to get her license. (Pennsylvania requires driving experience but not professional driving lessons to obtain a license. Personally, I took the Pennsylvania driving test at the Pennsylvania Highway Patrol driving course 56 years ago in a stick-shift car – and passed the first time!)

In an early study, nearly 17,000 young drivers in Ohio took this virtual assessment between July 2017 and December 2019. During the study, the tests were administered at motor-vehicle branches just before the young drivers took their license exams, though it wasn’t part of the exam. Once the drivers got their licenses, the researchers monitored state police crash-report records for the subsequent year, and compared how well the test-takers did. The kids who drove best ended up having a 10% lower-than-average crash risk. The ones who experienced major issues had an 11% higher-than-average chance of getting into a wreck.

The study, conducted by the Children’s Hospital of Philadelphia researchers along with colleagues from the University of Pennsylvania and the University of Michigan—with funding from the state of Ohio and other donors was published in the journal Pediatrics in October this year.

This spring, the researchers plan to study which interventions, such as behind-the-wheel training or online driver education, are most effective in helping teens improve driving skills. They hope to offer the virtual assessments in doctor’s offices around the country, where teens approaching driving age could take them as part of their annual checkups, just as they take vision exams.

“My dream is to start treating car crashes as the health risk they are for teens,” says Flaura Winston, a co-author of the study and one of the developers of the virtual-assessment software. “We want it to be part of routine preventative adolescent healthcare.”

Sounds like a great idea for young drivers – and for parents, too!

The Covid pandemic disrupted healthcare in many ways. Millions of people were unable to get the routine healthcare they needed because Covid fears and restrictions made it harder than ever to see a doctor. This resulted in the postponement of many elective procedures and routine medical screenings. The full impact of the Covid pandemic went way beyond the number of lost lives to Covid and the many hospitalized people who recovered. Many undiagnosed cancers , diabetic conditions, and heart disease led to many more deaths beyond Covid.

But now the pandemic is over, how is healthcare being impacted today?

Health insurers, who didn’t have to cover the myriad elective procedures that were postponed, braced themselves for the pent-up demand when the pandemic was over. But it seems their fears of elevated costs were not only prophetic, they were underestimated.

David Wainer, writing for The Wall Street Journal, tells us the return to care for things like knee and hip replacements surprised investors and insurers. Insurance companies thought they finally had a handle on things as 2023 progressed, but news from UnitedHealth and Humana about medical costs in the fourth quarter surprised investors, underscoring that a heightened demand for medical care is failing to abate. Humana recently flagged higher-than-expected costs in the fourth quarter, due to hospital admissions, members’ doctor visits, outpatient surgeries and use of supplemental benefits.

That came after UnitedHealth told investors last week that medical costs came in higher than analysts had expected. UnitedHealth said the medical-service use was largely a continuation of issues it previously flagged, including higher use of outpatient cardiac and orthopedic procedures by people enrolled in its Medicare Advantage plans.

This led to top stock-market movers telling the story of the winners and losers from the return-to-healthcare trade as the year gets underway. At the bottom of the losers column are insurers like Humana, CVS Health, Elevance, UnitedHealth, Centene and Molina—all payers. At the top of the gainers list are hospital chains like Tenet Healthcare and HCA Healthcare as well as medical device companies like Intuitive Surgical.

This is no surprise for anyone who has been following the impact of ObamaCare since it was passed by Congress in 2010 and implemented in 2014. Hospitals have been among the biggest winners since the government is now paying for healthcare they used to write-off for indigent care. Many of those who were formerly indigent now have ObamaCare or Medicaid due to wider eligibility criteria. Hospitals are also winning because of the influx of many physicians on their employee rolls that were formerly private practitioners.

These doctors are now performing routine medical office procedures, like EKGs, EMGs, kidney stone ultra sounds, and others under the billing codes of hospitals, which allow higher charges. The up-charges for hospitals can be greater than 100 percent. This explains the incentive for hospitals to acquire private practices, which is happening nationwide. Today, more than half, perhaps as much as 70%, of all doctors work for hospitals or other large corporate healthcare institutions.

If you’re an investor, you should be avoiding insurance companies with higher medical utilization, and favoring the medical providers over the payers. Just look around any growing city and you’ll notice many of the hospitals are expanding, constructing bigger and fancier buildings with their new-found earnings. They’re the real winners in the healthcare market today.

People often brag that they have “great healthcare insurance.” It is often the most important benefit employers can use to attract new employees. This can be very comforting to people who are concerned about their health and their future. But good healthcare insurance is not an end in itself; it is a means to an end. If the end never comes, what good is it?

There is reason to be skeptical of focusing too much on healthcare insurance instead of the quality of the health care delivered. John C. Goodman, writing for The Independent Institute at independent.org, says, “One reason the United States spends more on health care than other countries is that we are obsessive about health insurance instead of health care. When the British National Health Service or the Canadian Medicare system spends additional money, they spend it employing doctors, building hospitals or buying medical equipment. When the U.S. government spends more money, we give it to insurance companies.”

He cites ObamaCare as an example. According to Goodman, we are currently spending $214 billion a year insuring people through Medicaid (which is mostly contracted out to private insurers) and the Obamacare exchanges. At $1,731 for every household in America, that’s a great deal of money being transferred from taxpayers to insurance companies every year.

It is clear that insurance companies, and hospitals, are benefitting most from ObamaCare. You need only notice the size of their buildings in any downtown metropolitan community. But what about the American people? Are they getting the access to healthcare and the measurable improvements in their health that ObamaCare was supposed to deliver?

Nonetheless, one scholarly study finds there has been no overall increase in health care in the US since the enactment of Obamacare. The number of doctor visits per capita actually fell over the last decade. That’s surprising, because our population has been aging and older people require more health care.

Unfortunately, there is nothing particularly new here. When Obamacare was enacted, it was expected to cost close to $1 trillion over the next ten years. But there was no serious discussion of what we were going to buy with all that spending—not in Congress, not in the mainstream media, or even in the health policy community.

Goodman explains that Economics 101 teaches that all societies face a production possibility frontier. The typical textbook example is the choice between guns (military goods) and butter (consumer goods). In our case, it is health care versus other goods and services. To have more of one, you have to have less of the other. To have more health care, we have to have more doctors, more nurses, more hospital beds, etc. Without any increase in supply, for one group of people to get more care, some other group has to get less.

We saw a vivid illustration of that during the Covid pandemic. In order to tend to the needs of a sudden surge in Covid patients, health care providers had to delay care for the non-Covid patients. That has led to many more undiagnosed cases of cancer, heart disease, diabetes, and other chronic, life-threatening illnesses. The quality of their healthcare insurance didn’t change – but the quality of their health care deteriorated.

History tells us what happens when the healthcare delivery system doesn’t adapt to increased demand. Medicare for the elderly and Medicaid for the poor were huge programs, even when they were started in 1965. In a short period of time the number of people who lacked health insurance dropped from nearly 25 percent to under 15 percent of the population.

As a result, physician visits by low-income people increased 6.2% and surgical procedures among the elderly increased 14.7%. But since there was no increase in the ability of the system to supply medical services, these increases were offset by a decrease in care delivered to the non-poor and the non-elderly.

A study in the American Journal of Public Health found that “society-wide utilization of medical care remained unchanged.” Even though there was an increase in health care services for seniors, MIT professor Amy Finkelstein discovered that the passage of Medicare had no effect on the health of the elderly—at least as measured by mortality. The additional spending set off a bout of health care inflation for all patients, however.

You would hope that Washington politicians would have learned something from this experience. Sadly, there is little evidence of that. During the first term of the Clinton Administration, Hillary Clinton proposed a plan to reform the private health care system and insure the remaining uninsured. But although that proposal consumed thousands of pages of analysis and discussion, almost no one asked what the nation would have less of in order to have more health care. And nothing was done to increase the supply of doctors and nurses!

Has ObamaCare increased the delivery of health care?

Under Obamacare, the number of people without health insurance fell from 15.5 percent of the population in 2010 to 7.9 percent by 2022. Sounds good, huh? Yet the study cited above found that health care utilization across all of society did not increase at all! There was some shifting, as low-income patients got more care, but that care was offset by reductions elsewhere in the system. In particular, “a 3.5-percentage-point increase in the proportion of persons earning less than or equal to 138% of the federal poverty level with at least 1 office visit was offset by small, nonsignificant reductions among the rest of the population.”

It is clear we must focus more on the delivery of healthcare, rather than the insurance of healthcare, if we want to improve the health of all Americans. That is the goal, isn’t it?