Oct 31, 2011

Competing Societal Views

While most professionals dealing with consumer-driven health care focus on the elements of the plan, to some degree the views on consumer-driven health care plans are influenced by societal and/or political views. Proponents of the concept view the plans as giving plan participants "ownership/individual responsibility" over their own health treatments, spending, and choice of providers and to some degree for their own health status. Skeptics of consumer-driven health care fear this approach will reduce the health insurance risk pool, as healthy individuals move to high deductible policies, leaving the very sick and those with chronic illnesses in a shrinking risk pool and paying higher and higher premiums.
Supporters of consumer-driven health care believe this approach provides individuals with greater independence in the purchase of health care and provider selection. It also enables them to use the providers of their choice regardless of their employer or employment status. Certainly, consumer-driven health care can be a way to break the health care link between employer and employee. Individuals do not need an employer to set up an HSA. The individual only needs to have a high deductible health plan—which may or may not be offered by the employer. Skeptics of the plans see this elimination of employer "paternalism" as dangerous to the employee and to the community. These skeptics fear that without employer "paternalism" and its considerable role in restraining health care cost increases and improving health care quality through their greater bargaining power, health care will become even more expensive and less effective.
What both the proponents and the skeptics seem to ignore are two facts about employers and consumer-driven health care. First, poor health among employees causing both absenteeism and "presenteeism" has significant real dollar costs for employers. Consequently, employers have both an economic interest in keeping employees healthy and on the job and in controlling the cost of the health care necessary to accomplish that. The employer's role in helping employees find the most efficient providers and procedures is part of that cost control effort.
Second, the major obstacle to enrolling substantial numbers of individuals into consumer-driven health care could well be, as one case study found, that the plans must be carefully explained and supported. At least to date, employers are the most effective source of providing the initial introduction, explanation, and coaching necessary to fully maximize the benefits of consumer-driven health care. Individuals are likely to discount or dismiss information offered directly from health plans and insurers as simply a "sales pitch." Government has rarely successfully taken on the mission of pushing a specific insurance plan that government was not financing, nor is there an effective agency in existence today to take on that role. Even if such an agency existed, would it be trusted?

Will We Actively Accept Consumer-Driven Health Care?

Clearly the limited experience to date with consumer-driven health care cannot tell us whether this approach can materially contain costs and improve health or is simply the "new" new thing to cure the problem of escalating health care costs. Certainly, with an estimated 98,000 lives per year lost to medical "mistakes," a significant percentage of medical care determined to be unnecessary or ineffective, and an epidemic of obesity and its accompanying diseases, the sheer waste from not becoming better health care consumers seems abundantly obvious.
But will individuals actually take responsibility and make the effort to drive their health decisions? The experiences with smoking and drunk driving in the last two decades suggest publicity and a change in social mores actually can achieve better individual health behavior. Public campaigns driven by determined individuals as well as organizations but with relatively little involvement from government, considerably reduced smoking and its resulting diseases and reduced drunk driving and its deaths and injuries. These campaigns certainly did not end these health hazards, nor did they lead to a net reduction in health costs, but they did reduce the hazards and slow the rate of cost increases. On balance, consumer-driven health care is not a silver bullet for rampaging health costs, but it could be a shot in the arm for containing health care cost increases and improving health.


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