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.

0 0 votes
Article Rating
Notify of
Newest Most Voted
Inline Feedbacks
View all comments
13 years ago

Frankly, the notion that people are too ignorant to comprehend this added step is suspiciously patrician.

Problem solved! So, Justin, which is lowest in overall cost with best quality, 1, 2, or 3 dental cleanings per year?
How about colonoscopies? Which is likely to be lowest in long-term cost (and hopefully with killing me in the “bargain”): yearly screening beginning at 50, every other year, every 5 years, how about not at all?
(And on, and on, and on)

13 years ago

Russ and Justin,
Instead of nickel and diming things I like what the State of Hawaii did over 40 years ago (and the state has been tweaking the system every year because it was not perfect at the start); enact health care reform requiring all businesses to provide health insurance to anyone working 20 or more hours a week. Almost all the residents of Hawaii are covered by some type of medical plan making the state closest to providing universal healthcare for the approximately 1.4 million residents.
Those not working are covered by a state medicare program based on ability to pay but no one is turned away from medical care for failure to pay.
My move to Hawaii lowered my healthcare and dental insurance rates $100 a month verses living in RI with the exact same insurers at the same prime levels. Why? Healthcare reform or no healthcare reform?
Hawaii boasts the lowest state-wide healthcare costs in the nation; longest living population and less stressed population in the nation and I can tell you from experience I am being checked and called in to see my doctor and dentist (I pick them) more than I was in RI. A lot of preventive medicine out here in Hawaii!

Show your support for Anchor Rising with a 25-cent-per-day subscription.