Observed from Within the Complications

The complaints against high-deductible health insurance coupled with health savings accounts presented in Richard Salit's article, yesterday, seem more like groans against change than anything:

... some health experts say that you can't expect people who are ill to be cost-conscious consumers — even healthy people have difficulty price-shopping for medical services. That's why Christopher Koller, the state's health insurance commissioner, says the plans are no "silver bullet" for curbing the nation's health-care costs. ...

Higher-deductible plans can be challenging to understand. They include a new vocabulary of terms and quite a few acronyms to decipher. They also require people to get involved in managing their health-care expenses in a way they never have before.

The Coastal Medical group has witnessed first-hand how some patients get confused by the plans.

Sure, high-deductible plans are more confusing than top-of-the-line offerings that allow consumers to go anywhere at any time, but those are increasingly rare. In general, health insurance has hardly been a simple matter. Referrals, primary care, copays, coshares... most people, I'd hazard to suggest, already tend to go where they're advised to go and pay whatever bill is sent their way once the insurer has trimmed it down.

The only added complication, with high-deductible plans, is that the bills don't get trimmed until the plan member has paid a certain amount. When coupled with health savings accounts, that money just comes from them, first. Frankly, the notion that people are too ignorant to comprehend this added step is suspiciously patrician.

Koller does raise the reasonable concern that bills that patients find unpayable end up stuck on hospitals' and doctors' books. Similarly, employer Donald Nokes, who recently switched his company to a higher-deductible plan, observes that employees who had health issues during the year weren't as happy with the change as those who did not. Of course, they're likely happier than they would have been if the company had not been able to afford any benefit at all.

What unites Koller's and Nokes's points is that they are indications that the price-conscious reform of high-deductible plans and health savings accounts is still beginning. As such an approach becomes more common, more people will have years of healthy buildup in their savings accounts to absorb the pain of tougher years. When that's the case, fewer health care providers will find their invoices unpaid.

Above everything, though, what gets lost in the article is the comparison of doing nothing. Moreover, any reform that attempts to avoid the necessity of patients' involvement in their own care will fail to control costs, unless it puts decisions in the hands of supposed experts with the power to deny care.

We have no choice, that is, but to choose the path of education and individual investment.