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POLICY/HEALTH PLANS: More communism at the Wall Street Journal

More radical Bolshevism at the Wall Street Journal. Venessa Furhmans is now saying that Health Savings Plans (are) Start(ing) to Falter. How dare she!  She’s going to get it when Rupert takes over!

On the other hand, just dumping people into HSA and CDHPs was always going to raise dissatisfaction, and people, in general, do not want to shop at the point of care for medical treatment because it’s really, really hard.

In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses. Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative. "If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I’d be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin’s health-care consulting practice.

Still it’s a little ironic that a benefits guy is knocking CDHPs. After all, who the hell has been pushing them all this time?  And (to quote myself), remember kids, the CDHP is the bastard child of a one night stand between a benefits consultant with nothing to sell and a right-wing think tank that can’t do basic math.

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9 replies »

  1. not to quibble, sonoma, but this:

    “regarding the 401(k) analogy, a portion of that money comes out of the employee’s paycheck, whereas all of the HSA contribution comes from the employer. Big difference.”

    makes little sense. Most employers make no contributions whatsoever to employees’ HSAs. You may be thinking of Health Reimbursement Accounts.

  2. Posted by: sonoma
    “Bottom line is that consumers are familiar with difficult purchasing processes. Ever bought a car? A house? Shopping around for medical car can’t be that hard.”
    Just because consumers “shop” for houses and cars doesn’t mean they know what they’re doing and make the right decisions. If fact most consumers go on gut feel and emotion, not facts. Ever buy a house then start finding out all the reasons you shouldn’t of bought it -at least at the price you paid. Ever bought a new car then had it recalled for safety problems, or worse, the manufacturer tried to hide known defects. Ever bought a used car and regretted it.
    I wonder if you’re going to get a notice from the medical school that your doctor’s medical degree is being recalled for public safety reasons.
    To begin to get this solved we need to stop considering healthcare as just another consumer product – it’s not.

  3. I think the, eventually, consumers will have more tools available, such as on-line pricing information along with quality ratings. This will certainly simplify the process.
    Regarding the 401(k) analogy, a portion of that money comes out of the employee’s paycheck, whereas all of the HSA contribution comes from the employer. Big difference. As soon as employees realize that, when used correctly and with a little bit of effort, they can accumulate rather large sums of money in the HSA, they’ll do it.
    Bottom line is that consumers are familiar with difficult purchasing processes. Ever bought a car? A house? Shopping around for medical car can’t be that hard.

  4. Matthew,
    The article highlighted the critical gap in “providing” an HDHP/HSA with no support and catalyzing consumerism with the right level of advisory / support services.
    My take is that the gap provides an opportunity for companies to jump in and provide the services required to help consumers get enough experience and confidence to really engage as consumers. My thoughts on the article can be found at:
    http://scottshreeve.blogspot.com/2007/06/priming-pump-jumpstarting-healthcare.html
    I have had an HSA (MSA) since the beginning (2003) and can clearly see the advantages. I have paid significantly less in overall healthcare expenses each of the four full years since switching to this type of insurance. I do share, with many of you readers, the frustration of trying to be a “consumer” (there is hardly any comparative information, minimal outcomes information, and the system remains extremely prickly in terms of navigation).
    I still believe taking responsibility for my health, making informed decisions, being protected against catastrophe, and having a health system focused on delivering healthcare value is a reasonable approach to reforming the American health system.

  5. So some people expect professionals to be monks and nuns. Hmmmmm. That actually is the original meaning of the word: one professed (religious) vows. What the professionals fear is that they’ll be paid like monks and nuns if this expectation becomes too widespread.
    > services are well beyond the incomes
    > of, say, 99% of all Americans.
    This is like saying home prices are well beyond the incomes of, say, 99% of all Americans, or that new cars are beyond the incomes of, say, 85% of Americans.
    t

  6. People don’t want to shop because they expect a profession like medicine, which requires accreditation, to contain professionals who understand an insanely complex topic, know how to approach and solve problems, and are sanctioned by the state to provide appropriate care after making a personal commitment to what is essentially a never-ending way of life.
    Why the should they have to “shop around?” This isn’t about buying a copier. It’s about something’s wrong with a human being, whose body science still doesn’t fully understand.
    Frankly, I don’t WANT to try to shop around because I CANNOT EVER be an informed “consumer.” This is where the productization of healthcare is a giant, money-sucking scam perptrated on sick people by unscrupulous, heartless bandits.
    Take your market forces and force them on someone else, please.
    I am willing to pay for services, but services are well beyond the incomes of, say, 99% of all Americans. This is why it is a SOCIAL COMMITMENT to share the cost of care among everyone, not just shuttle the risks off to die.

  7. I’m a self-employed physician with an HSA, and even I have trouble using the thing effectively. In spite of the inside knowledge I have of the system, it’s just as hard for me to find out how much things really cost as it is for anyone else.

  8. > people, in general, do not want to shop at the
    > point of care for medical treatment because
    > it’s really, really hard.
    They do not want to shop for medical services at all because its really, really hard. They do not want to shop for doctors, treatments, health plans, nothing. They want the very best for free and at whatever level of satisfaction the tort bar tells them they’re entitled to. Never mind there is often disagreement about what the very best is and might well be very little.
    Remember who the benefit consultant works for. His concern is to retain talent at the least cost to the employer. If the only thing people do is whine about the HD/HSA plan and don’t change jobs or demand time off for shopping or demand more money to compensate them for time spent shopping, their dissatisfaction does not count for very much. And they may not be all that dissatisfied until someone in their family gets sick or hurt.
    This is not to say that people should not shop for either a health plan or a smart PCP. They just don’t want to, and for practical purposes there is insufficient information in the market to make a rational (or semi-rational) choice. Which is part of the reason shopping is so hard.
    t

  9. I actually have an HSA, so watch it! (: However, I see consumer reaction to these as a direct recapitulation of 401k plans, in which data show that most people don’t do anything with them, don’t know or care how to manage them, etc. – to their future severe detriment.
    Bottom line is, people are lazy – they do not want to take personal responsibility for their own welfare, they want others to do it for them. Not confined to healthcare……

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