Millions of Americans may sigh at Bertha, Barney, or Betty, or whatever they’ve nicknamed the beat-up family vehicle parked out front: “Wouldn’t it be great, if only we could afford a nicer, newer model?”

A big obstacle to that wish, however, may be the increasingly costly and unaffordable health insurance they get at their workplace. New research finds that the annual premium for family coverage  — forked over mostly by companies but also by workers — now averages $20,576, according to an annual survey by the nonprofit, independent Kaiser Family Foundation.

Drew Altman, chief executive of the group, commented to the Wall Street Journal about the spiking burden of workplace coverage: “It’s a milestone. It’s the cost of buying an economy car, just buying it every year.”

To be sure, workers don’t bear the full cost. Their employers do. And they’re groaning, too, under the growing expense.  But the newspaper also noted:

“Employees’ costs rose at an even faster clip — the average annual amount workers paid toward premiums for the family plans grew 8%, to $6,015 this year. The average deductible for single coverage, which employees pay out of their pockets before insurance kicks in, went up as well, to $1,655, though that didn’t factor in plans with no deductible at all. For an individual employer plan, the average total premium cost was $7,188 in the 2019 survey, or 4% higher than last year.”

Leave it to the financial journalists to provide a painful and pithy description of the issues with employer-provided coverage:

“The rate of growth in coverage costs, including those borne by employees, continued to outstrip rises in inflation and wages … squeezing workers despite a low unemployment rate that might encourage companies to sweeten their benefit.”

The New York Times reported on one small business owner’s financial headaches with workplace coverage. His family plan costs him $2,000 a month, or $24,000 annually. To make the policy affordable, it also socks him with a $13,000 annual deductible, so says this businessman: “I’m out $37,000 before I see a return on investment, if you will.”

While that stings, the Kaiser study found situations as bad or worse for other workers:  Those who earn less, even the least in companies, often must pay more for their company-provided health insurance. That forces many of them to forego coverage and to take risks with their health and finances.

The data and anecdotal evidence, unearthed in journalistic reporting on the cratering of workplace-provided coverage, combined with soaring deductibles, may rebut the poll-based argument that Americans “like” the health insurance they have. This has been a frequent survey response among the 153 million — the preponderance of us   — who get covered through our jobs.

It may have given license to those who have waged loud, brutal political battles over the 27 million or so poorer and middle-class Americans who have sought and received help with health insurance through public exchanges, as provided under the Affordable Care Act, aka Obamacare. But it has stranded too many Americans, leaving them to struggle with employer coverage that they can’t pay for and don’t benefit from because they lack the money (savings) for out-of-pocket costs like whopping deductibles.

Let’s knock off the talk about savvy health shoppers

Workers’ wrangling with medical costs may, instead, put to an end a painful and wrong policy-maker theory — that consumers, when they have “more skin in the game” with higher premiums and deductibles, will make choices and help drive down the cost of medicine by skipping frivolous care. This fanciful set of beliefs also argues that patients won’t ration care but will become savvier shoppers, hunting for medical bargains as they might find cheaper groceries or second-hand designer shoes.

Washington correspondent Noam Levey torpedoes this fallacious thinking, reporting in the Los Angeles Times:

“Although Americans are willing to seek out lower-priced generic medications, few are comfortable shopping for medical care, studies and surveys show. Patients … who do try are often frustrated by incomplete or inaccurate information from insurers, hospitals and other medical providers. Just 1 in 6 covered workers even tried to shop for the best price for a medical service in the previous year, according to a nationwide poll conducted … by The Times and the nonprofit Kaiser Family Foundation. Two-thirds of workers with job-based coverage said finding the cost of a medical treatment or procedure was somewhat or very difficult. Meantime, prices for medical care and prescription drugs haven’t moderated, as advocates of high-deductible insurance predicted. Instead, they have soared. The average price of a knee replacement, for example, shot up nearly 80% between 2003 and 2017, increasing at more than double the rate of overall inflation, a Kaiser Family Foundation analysis of commercial insurance data found. These price hikes are crushing insured Americans: 1 in 6 workers with job-based benefits in the Times/Kaiser Family Foundation poll reported that they had to make a “difficult sacrifice” in the past year to pay for healthcare, such as cutting back on food and other essentials.”

While they’re getting squeezed too by soaring health care costs, companies’ shifting of that burden — and shafting their own employees  — has provided the rocket fuel of public anger that has made health care a top issue in the 2020 election campaign.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal as the cost, complexity, and uncertainty of treatments and prescription medications skyrockets, with too many drugs also proving to be dangerous.

Americans, as they size up the fields of political candidates, should be clear that Republicans have labored for a decade to kill Obamacare without providing a better alternative. Instead, they have pursued, for example, a dubious legal case that’s pending now. This appellate assault on the ACA could strip patients of preexisting condition and lifetime limit protections, as well provisions that call for preventive treatments and women’s reproductive health care.

The Trump Administration will create chaos if it kills the ACA without options to replace it. Republicans shouldn’t be surprised if employers also the strip workers for preexisting condition and lifetime limit protections, if they’re not demanded by Obamacare. Consumers also already are getting unpleasant shocks when they discover that “skimpy” health insurance plans, promoted by the Trump Administration for their lower premiums but also their negligible benefits, leave them with zero help when they get sick or injured.

We’ve got a lot of work to do to make health insurance and the health care system work much better and more affordably to benefit us all. The next elections will be critical in doing so.