Went to the doctor last week – time for my annual physical. I’m one of the lucky ones, not just because I have a good doctor, and not because my blood pressure is good, or my cholesterol (albeit chemically-assisted) is 150, but because I have a good employer-provided health plan.
Employer-provided health insurance seems to be another one of those things that is headed for the dustbin of history. Health care costs keep going up, health insurance costs keep going up and, more and more, employers are looking for ways to reduce their costs. Understandable, really, when health care costs and the insurance used to pay for them increase at twice the rate of inflation.
One of the most common ways employers reduce their costs is to pass a greater share of the cost of health insurance to employees. There is also a new (not really so new, but we’ll consider it so for the sake of discussion) trend toward so-called consumer-directed health plans built on high-deductible insurance coverage combined with some form of health savings or reimbursement account. The basic theory is that if employees have a financial stake in the choices they make, they will make better choices, thereby reducing costs.
Shifting a greater proportion of costs to employees will certainly save employers money. Whether high-deductible plans or other means of giving employees a greater financial stake in their health care consumer decision-making will result in cost savings or better outcomes remains to be seen (see “VI. Conclusions and Future Research Needs.”).
The means of providing and allocating health care in this country are a mess. The system is broken. More and more people go without health insurance, and fewer and fewer people get health insurance through their employers. There are those who downplay this issue by saying things like “not all 47 million are Americans” or “some of those 47 million choose not to have health insurance.” I suspect both of these assertions are true, but does that matter? When someone shows up in the emergency room, more often than not they are provided care regardless of their health insurance status or ability to pay. When these people don’t show up for work it creates a drag on the rest of the economy. Do we think this “charity care” or “bad debt” is free? No. We all pay for it in, among other things, higher health care costs and higher health insurance premiums.
So, saying there are 47 million people in this country without health insurance doesn’t tell anything like the whole story. We have a system that does not provide sufficient access to preventive care to avoid more costly treatments in the future, like trips to the ER, or interventions that might have been avoided with earlier attention. And it punishes those individuals, employees, and employers who have or provide health insurance (or pay their medical bills) by consistently raising prices at rates significantly higher than inflation to compensate. It’s an ugly spiral, and I’d like to know when and where it will end.
Something worth asking your local candidate for president when they come to sip coffee and turn colors in the living rooms of New Hampshire and Iowa this fall.