The coming healthcare cost crisis is not the one academics are used to focusing on — i.e. societal healthcare expenditures, which appear to be falling sharply. The cost crisis upon us is spiraling unaffordability of care due to soaring uninsurance & underinsurance.

That healthcare spending can fall while healthcare unaffordability increases might seem paradoxical but it’s of course not — witness poor countries that have “inexpensive” healthcare defined as per capita health expenditures, even while care is totally unaffordable for most.

Underinsurance will rise in this crisis even if deductibles and copays remain the same, because disposable income will plummet for many — making those copays and deductibles unaffordable.

Meanwhile, we’re likely to see millions more uninsured — 7 million+ by one estimate — in coming months. As unemployment increases, so will uninsurance, given the fragmented nature of our financing system (even in Medicaid expansion states, although worse in non-expansion states)

A second wave of suffering is inevitable if we do not address worsening uninsurance and underinsurance, which will affect both children and adults. Out-of-pocket health costs should be fully covered by Medicare during the crisis, until a rational financing can be implemented.