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High-deductible health plans mean high risk

Written by Diane Archer

In a recent opinion piece for Stat news, Ashish Jha, M.D., describes his struggle ensuring the health and well-being of himself and his family with their high-deductible health plan. Jha shows how high-deductible health plans mean high risk, even for a well educated, well-to-do doctor and professor of health policy at Harvard University. He reminds us why people so highly value traditional Medicare, which offers easy access to needed care.

Dr. Jha wanted to see what it was like to bear the financial and emotional burden of a high-deductible health plan, as do about one in three American workers. He assumed that with his medical acumen and networks, he and his family would assume few risks. But, he was mistaken, even though his family could afford the $6,000 deductible.

He discovered what Congress still needs to learn: Unlike traditional Medicare, high-deductible health plans lead people to gamble with their and their family’s health, requiring them to make a choice that no one should be asked or required to make. When people get sick, rather than helping to ensure they see a doctor, high-deductible health plans make cost a strong consideration, promoting stress and putting people’s lives at risk. Here’s why:

  • You often can’t predict your out-of-pocket health care costs, since many health plans don’t make price information available.
  • Moreover, you generally cannot control your total costs even when you can comparison shop based on the price of individual services. It’s virtually impossible, even for doctors, to know what array of services the doctor you visit will provide for a given condition.
  • And, even if you could know what your services will cost you from different providers, you shouldn’t be shopping for medical care based on price alone. As with automobiles and food, quality matters a lot. But, health care quality information is largely unavailable.
  • Finally, the cost of care shouldn’t keep you from seeing the doctor. But, high-deductible health plans can put people who get sick and who worry about affording the cost of care–the vast majority of us–in the untenable position of deciding whether to gamble with their or their family member’s life.

Dr. Jha was forced to decide whether to give his son a one-year post surgical follow-up visit at a cost of $465 or not. He had no clue. Should a person–even when a doctor–be forced to make that choice?

Because he had a high-deductible health plan, Dr. Jha was also put in the terrifying position of deciding whether to go to the emergency room when his heart beat furiously for more than an hour, and his chest began hurting. As a doctor, he knew he was at risk of a heart attack. As a consumer, he knew he’d be on the hook for several thousand dollars if he called 911. So he rolled the dice. The data show that one in four Americans go without care because of high-deductibles.

Dr. Jha observes that our commercial health care marketplace, for all its talk of choice and innovations to meet consumer needs, fails us. If he opted to get care, he would need to go to the nearest emergency room and to pay an exorbitant price. He did not have the choice of getting care at a lower cost clinic, which, as an internist, he knows is all he needed.

It goes without saying that commercial health insurers have no interest or ability to drive many key health care marketplace changes. They often generate higher profits from insurance premiums when health care spending is higher. And, in most markets, they have no clout to drive improvements because there’s no competition.

High-deductible health plans may save the health care system money, but at what price? How many heart attacks do they avert, how many lives do they lose?

Here’s more from Just Care:

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