The National Business Group on Health
predicts that the majority of so-called health insurance plans will soon be high deductibles, or at least so it was quoterd in the Tennessaean (find the article here). Excerpt:
December 27, 2011
High-deductible health plans on rise
By Tom Wilemon
Corporate employers, small businesses and nonprofit organizations are increasingly requiring their workers to spend between $1,200 and $5,000 before filing a health insurance claim.
Nearly three in four employers will offer at least one of these plans next year, according to a survey by the National Business Group on Health, a nonprofit association that represents large employers.
Helen Darling, its president, predicts that by 2016 the majority of all health plans will have high deductibles.
Dr. McCanne's comment:
The National Business Group on Health (NBGH) is composed of the nation's largest employers, predominantly Fortune 500 companies. They provide health coverage for over 50 million workers, retirees and their families. When NBGH's president, Helen Darling, says that three years from now the majority of all plans will have high deductibles, you can bank on it.
Although this development is independent of the measures in the Affordable Care Act (ACA), it has greater consequences than any other feature of ACA, merely based on the number of people who will be impacted - not just the Fortune 500 company employees, but virtually everyone else as well.
Most workers and their families obtain their health care coverage through their employment. With large employers leading the way, high deductible plans will become the national standard. For median-income households, the deductible is large enough to create a financial hardship should a family member have significant health care needs. Thus, under-insurance is becoming the new norm, not only for employer-sponsored plans, but also for the low actuarial value plans to be offered through the state insurance exchanges.
The rationale usually given for high deductibles is to make patients more sensitive to the costs of health care so that they will use less of it. This has been shown not only to decrease the use of beneficial health care services, but it also potentially exposes people to financial hardship when they develop problems for which health care is absolutely essential.
So the question is, does this really save enough money to warrant these adverse consequences? Let's look at the RAND HIE and also the experiences of other nations.
The RAND Health Insurance Experiment demonstrated that health care use was reduced by 30 percent in patients with cost sharing as compared to first dollar coverage, supposedly without resulting in harm (though low-income people were harmed). But that study was limited to healthy workers and their young healthy families during a few healthy years of their lives. It does not apply to the relatively unhealthy 20 percent of people who use 80 percent of our health care dollars - care that is not influenced by deductibles. Reducing spending by 30 percent on healthy people who use very little care - perhaps an office visit or two - is not going to reduce our national health expenditures significantly.
Many other nations have first dollar coverage with no deductibles, yet spend far less than we do, and with no evidence of significant overuse of medical services. There are far more effective and much more patient-friendly methods of controlling spending than the use of deductibles and other cost sharing, as these nations have demonstrated.
The Affordable Care Act is not providing us the framework that would ensure affordable care for everyone. Trying to modify the Act to make it work better won't help because the financing infrastructure is so fundamentally flawed that legislative tweaking cannot repair it. Though getting rid of deductibles would be an improvement, it wouldn't reduce our high costs, but would merely shift them, making insurance premiums even less affordable.
For this new year, we really have our work cut out for us. The public at large needs to understand the irreparable flaws in the ACA model of reform.
The Affordable Care Act is penny wise and pound foolish. Pushing all of us into high deductible health plans will cost money, not save it.
Make a resolution right now to help us get health system reform done right.
Dr. Joe Jarvis