High deductible health plans don't work for the already-sick.

[feuervogel]

I've been saying that for years, and finally there's some evidence.

Atul Gawande, via Ezra Klein:

The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, tests, and procedures -- make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise -- climbing almost ten per cent each year. The company was baffled.

Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions -- in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.

The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late.

If you're young and generally healthy, or if you have a high enough income to support putting away $5000 or more a year, a HDHP + health savings account may work for you. If you're the other 80% of the population, chances are it won't.

Comments

[ladyegreen.livejournal.com]

Couldn't agree more. Spot on.

[feuervogel]

I wrote a paper during my pharmacy practice residency about how decreasing patient out of pocket costs for prescriptions would (obviously) increase the insurance company's spending on drugs, but it would save them money on hospitalizations. The problem is that most insurers take a silo view of spending. That is, they look at each segment of costs in a vacuum, and drug costs going up is BAD!! so they make patients pay more so drug costs go down. Then they don't look at the amount spent on ER visits and hospital admissions increasing as silo A gets smaller.

The "get some skin in the game" aspect of conservative economic thought makes me want to stab somebody. Easy to say that if you have lots of income and can afford the extra copays (or full-pay for doctors' visits, prescriptions, etc, until you hit your $5k deductible).

[ladyegreen.livejournal.com]

Were you on my flist when I got my ear infected and wound up with half my face paralyzed for a while? I couldn't afford a doctor's visit for my ear infection. A lot of people came to my aid on line and with my family but it was already to late.

I wound up having to go the emergency room to rule out a stroke (inner ear problems and you know paralyzed face with slurring). My right eye had to be tapped shut for a while. I still get weird nerve pains and jerks in my face and my a good bit deaf in my right ear.

Thousands of dollars and permanent damage because people believe so hard in the "get some skin in the game" aspect instead of the "be a decent human being" aspect. (And I never did see the specialist they sent me to for nerve damage because they wanted 300.00 dollars for me to walk in the door. Not kidding. No insurance, 300.00 upfront.)

[feuervogel]

I don't think I was. That's awful! And not surprising in the slightest. For-profit insurance is of the devil.

[tiurin.livejournal.com]

There are plenty of people who do need to get more skin in their game, but they Republicans generally don't mention those. Investment bankers and hedge fund managers, for starters.

I think what I do is far more honest than I-banking.

[feuervogel]

Those bastards need to stop rewarding luck and calling it skill. In that respect, yeah, playing poker for a living is far more honest: you acknowledge that it's gambling and that there's a measure of both skill and luck involved.