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Workers Ungrateful for Empowerment to Pay More

6a00d8341c909d53ef0115702ff0f9970b-pi American workers sure are ungrateful.A new report by the National Business Group on Health (NBGH) says that 27 percent of insured workers are skipping health care treatments to avoid co-payments, 20 percent of employees are not taking their prescriptions as advised by their doctors, and 17 percent of employees are cutting their pills in half to make them last longer.Yet rather than expressing gratitude for the opportunity to express their consumer-driven preferences, and rather than praising the benefits consultants and conservative think-tank talkers who have given them the chance to have “skin in the game,” 58 percent of those surveyed said they “continue to be surprised” at their out-of-pocket costs. Obviously, they haven’t been attending conferences of HR execs, or they’d know that one man’s “cost shifting” is another man’s “empowerment of my employees.”It turns out that shopping for health care is not like shopping for a refrigerator and that changing co-pays and deductibles has to be undertaken with a great deal of care. Workers, hard-pressed financially by a deep recession, workers are not craftily eliminating unnecessary and non-evidence-based care. Instead, they’re pill splitting or skipping the pills entirely. This is precisely what the landmark RAND Health Insurance Experiment research on copayments and deductibles predicted more than two decades ago, which would be no surprise had the study consistently been quoted honestly by all proponents of the so-called consumer-driven health plans.

Of course, what goes around, comes around. Since 68 percent of employees say that having access to health benefits is a key reason for staying with their employer, it will be that same employer who picks up the tab for the consumer-driven diabetic who has to drive her consumer self to the emergency room because she couldn’t afford her medication. However, the good news is that a majority of workers polled said financial incentives from their employers have motivated them to try to lead a healthier lifestyle.In fact, about half of workers now agree that fat people and smokers ought to pay higher premiums. That’s only fair. And I think guys who have personal trainers and executive physicals should pay less, too, don’t you? Oh, wait. That wasn’t on the questionnaire.Why not just eliminate health insurance altogether and instead give every worker a shiny apple a day? (To keep the doctor away, of course.) If any HR execs, benefits consultants or conservative policy wonks out there would like to adopt this proposal, you can call it One More Fruity Idea for Health Care.

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footballTom LeithMD as HELLPeterrbar Recent comment authors
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That brings us to quite possibly the most intriguing match-up to that point of the season when Oregon comes to Rice-Eccles.
With the help of online resources you can easily find several online gaming sites.
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any margin, and it becomes tough for the organisers to handle that.

Tom Leith
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Tom Leith

Nate asks: > why do we send so many trillions to DC for them to > send it right back to the states with conditions, it > completly violates the concept of a federation we > were founded on. Several reasons, interrelated. 1) “Progressive” thought comes in two strains, at odds with each other. One strain seeks freedom from all authority. The other strain seeks freedom from Hobbes’ “state of nature” and poses Leviathan as the answer. 2) The concept of a federation we were founded on is upside down — there really is no Constitutional way for the Federal… Read more »

Nate
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Nate

to bad we can’t vote on Federal propositions. I could see one calling for all federal and state elected officials to be enrolled in their State Medicaid plan passing overwhelmingly. Wonder if you could somehow pass a binding prop on the state level calling for your officials to waive the federal plan and enroll in medicaid? I would love to see an honest discussion on Tom’s comments, why do we send so many trillions to DC for them to send it right back to the states with conditions, it completly violates the concept of a federation we were founded on.… Read more »

Deron S.
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“Public policy is too blunt an instrument to deal with individual cases.”
I can only hope that a fair amount of people are still following this thread, because that was one of the most important points raised on THCB in quite some time. I only wish policy makers could have the same daily exposure to the bastardized Medicaid system that I have.

Nate
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Nate

nicely said

Tom Leith
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Tom Leith

MD as HELL asks: > If the bank will not loan a patient money for > healthcare, then why should the government > borrow on their behalf? It shouldn’t. What we’re seeing in government welfare programs right now is similar to what we saw back in the days of “National Banking” where legislatures around the world controlled monetary policy. Those spectacular failures gave rise to “Central Banking”, the quasi-private-public system now in use. And I think we’ve recently learned that any sort of financial institution that performs bank-like or insurance-like activities ought to be regulated that way no matter what… Read more »

MD as HELL
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MD as HELL

GM is bankrupt. USA is next unless we get a new business model. GM was crushed by unfunded liabilities. USA will be crushed by unfunded liabilities, too, like Medicare and Social Security. If we think we can have healthcare for everyone and borrow to fund it, we will be bankrupt. Most people are healthy. Most people with coverage never use it. If not provided by employers, most people will never buy coverage out of pocket. If the bank will not loan a patient money for healthcare, then why should the government borrow on their behalf? Tort reform is the first… Read more »

Margalit Gur-Arie
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Nate, I don’t give a damn about political party lines. HMOs are a disaster as far as I’m concerned.
Regarding cheaper alternatives, such as generics, I think most doctors are very aware of that and are trying to prescribe generics whenever possible. It’s most likely a shared responsibility.
As to CDHP, if the only consumer driven spending occurs for the first couple of thousand dollars, how much savings do you think can be achieved? Or are we looking at making more and more of the health care dollars consumer driven, which implies less and less coverage?

Deron S.
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Margalit – The data is there to measure cost and quality. It just needs to be unlocked and utilized. It might require a national “standards” organization to package and disseminate the information. I’d like to see providers specialize in conditions, such as diabetes. In my mind, that will be the model of the future. Peter – Apparently I haven’t explained my point very well, so I’ll try a different approach. What do you feel is the most effective way for healthcare services to be paid for? In other words, who should pay and when and how should they be paid… Read more »

Nate
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Nate

When an insurer writes a large group they are getting all of those employees. If one person in that group is sick the premium from the other 999 makes up for it. It’s a captive pool. If your a small employer or individual and you have a large claim the only pool to spread that claim over is their block of business. This is where the left gives insurers a bad name unjustly. In concept writing one individual who gets sick and spreaking their claims over the pool works fine, we wrote insurance for decades like this. Then consumers wised… Read more »

Margalit Gur-Arie
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Nate, thank you for taking the time to answer my questions. However, I still don’t understand why I pose a smaller risk to an insurer if I work for a large corporation. I do understand the calculations, but I think that they are basically flawed and unnecessarily complex. Deron, what exactly would it take to make value based purchasing of health care possible? Let’s say a diabetic is looking for a physician. What would be the indicators to check? How he fares on the PQRI measures for diabetes versus his published price for office visits? Should we have little red… Read more »

Peter
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Peter

“because it completely ignores the fact that it works in every other industry.”
Again a failure to recognize that heathcare IS NOT like every other industry – unless you want consumers to get medical degrees. “The study you referenced does not discredit the CDHP concept, it discredits the results to date.” Say what? When exactly will you recognize that the facts do not support the concept? The context IS CDHP is that it is a stop gap stratagy by the profit providers to delay the inevitable of government control of healthcare.

Deron S.
Guest

Peter – I don’t recall making the claim the CDHP is the only tool for attacking cost growth. You seem to have tried to start another discussion there. With regard to your main point, it seems that you skipped a lot of the discussion or left out a lot of context. That’s a political tactic and you should know by now that politics is a zero-sum game. I made it very clear that, while I think CDHP is a solid concept, it was not rolled out without first making value-based purchasing possible. The study you referenced does not discredit the… Read more »

Nate
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Nate

Did you miss this on the front page Peter? “The RAND Health Insurance Experiment (HIE) showed that modest cost sharing reduces use of services with negligible effects on health for the average person.” This is very important for those numerous progressives that want to complain about high deductible then ignore the cap on OOP that is usually lower with CDHPs. “Furthermore, all the Experimental cost-sharing plans had a stop-loss feature that was at most $1,000 for medical spending for the entire family for a year and less for lower income families. (The $1,000 is in late 1970s dollars, which is… Read more »

Peter
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Peter

Deron, did you read the Rand Report before attacking the commentor? What ideology do you think Rand is supporting? In short people don’t have a clue what their “shopping” for nor does consumer driven healthcare drive improvements – but I bet it does drive better marketing. “On the other hand, the HIE showed that cost sharing can be a blunt tool. It reduced both needed and unneeded health services. Indeed, subsequent RAND work on appropriateness of care found that economic incentives by themselves do not improve appropriateness of care or lead to clinically sensible reductions in service use.[3] In addition,… Read more »