In the health care debate – as in most debates – it all depends on your perspective. People with awesome group health insurance benefits that are paid for by their employer might think that everything is fine the way it is. People who don’t have an option for employer sponsored coverage and can’t afford or qualify for individual health insurance probably see it a little differently. People who are healthy and rarely use their health insurance are probably less likely to see the problems that exist in our system. But people who battle chronic illnesses get up close and personal with the flaws in our health care system on a regular basis.
Duncan Cross is very familiar with the health care system in the US. He’s been through more than his fair share of medical procedures. And he’s not impressed with a recent WSJ editorial that calls for Americans to take on more of the cost of their health care. I can absolutely see his point. He’s had to self-ration health care because of money. He struggles to afford COBRA. He’s already paying a good chunk of his income for health insurance and health care. And his chronic illness means he’ll have to keep doing so indefinitely.
But I think that the WSJ editorial might have been aimed at a different sector of the population. Although there are plenty of people like Duncan Cross who pay all of their own health insurance premiums and then have to continually pay out additional amounts for treatment of chronic illnesses, there are others who pay little or nothing for their health insurance premiums (thanks to employee benefits) and have very low copays when they seek care. I was talking recently with a friend who is pregnant. She had a baby a few years ago, and spent a total of $200 for the pregnancy and delivery. She mentioned that her new health insurance plan is “nickle and diming” her, because she had already spent $200 for prenatal care and ultrasounds, and was going to end up paying another few hundred dollars by the time the delivery (a scheduled c-section) is complete. This is the sort of person that I think the WSJ editorial is aimed at. I honestly don’t think that she knows or cares how much her prenatal care and surgical delivery cost. Her portion is a tiny fraction of the total, and yet to her it seems like a lot of money. It’s all relative. I have a friend who paid $7000 for her c-section delivery – and yes, that was with health insurance. Both women had employer sponsored health insurance, but with drastically different coverage.
Proponents of HSA qualified, high deductible health insurance plans say that they make people think twice before utilizing health care. The jury is still out on whether this is the case. I know that a lot of our clients in Colorado request HSA qualified plans, mainly because the premiums tend to be lower. Jay and I have an HSA qualified plan, and it has worked well for us. But we’re healthy, with no chronic medical issues, and we’re the sort of people who would think twice (or six times) before utilizing health care anyway. Even when we had fancy group health insurance coverage with $15 copays, we never went to the doctor. I have a feeling that a lot of our clients who request HSA qualified plans look at health care the same way. We don’t mind shouldering a potentially hefty chunk of our health care costs, because we typically don’t have much in the way of health care costs. I have a suspicion that the people who wrote the WSJ article are probably in a similar position. But the perspective probably looks a whole lot different if you’re not only paying for your own high deductible health insurance, but also facing the prospect of meeting that deductible year after year.
I found Duncan’s article in this week’s Grand Rounds, hosted at ACP Internist.