Conservatives are out of sorts these days about the direction in which health care is headed. They think the new health reform law expands the role of government too much and spends too much at a time when they believe deficit reduction should be a higher priority. The claims about death panels and a government takeover of the health system aside, these are principled positions for conservatives to take – they are supposed to be for smaller government and less public spending. But for all of the frustration and even anger within the conservative movement about where health care is headed, the fact of the matter is that they are winning more than even they may realize in the current health care equation. That’s because the nature of health insurance itself is being redefined and moving gradually but seemingly inexorably in the direction conservatives have long advocated: more consumer ‘skin in the game’ through higher patient deductibles.
So begins Drew Altman, the President and CEO of the Kaiser Family Foundation, in his Pulling It Together… column. Altman, for the record, is not a conservative.
But he makes an interesting and, in the age of Obamacare, usual argument: that healthcare is changing and, in some ways, changing along conservative lines.
His evidence? He notes that more and more Americans find themselves with higher deductible plans – a major shift from the zero deductible, zero co-pay Blue Cross plans of old.
Altman notes, for example, that: “The percentage of workers facing high deductibles – $1,000 or more for single coverage – has been growing rapidly. It doubled from 10 percent to 22 percent between 2006 and 2009, and increased from 16 percent to 40 percent in small firms.”
High-deductible plans aren’t necessarily good news, nor are they necessarily conservative. On the right, people have espoused the idea of consumers, empowered with information and health dollars, being more involved in health decisions. High-deductible plans, without relevant information to the individual, can be chaotic and counter-productive.
That said, a well-designed plan with pricing and (some) quality information could be transformative. And – while few and far between – there are examples of that in the marketplace today. See, for example, this nice description of the Safeway experience.
It’s difficult to tell what impact Obamacare will have on healthcare insurance policies. If Washington takes a page from Boston, high-deductible plans will go the way of the dodo bird.
But I’m inclined to agree with Altman – the market is changing. And, regardless of who wins the Obamacare debates of the next few years, I’ll suggest three trends in health coverage:
1. More Information, Please
The health economy is changing the way the rest of the economy did decades ago – with savvier consumers demanding more and better information. Even if the single-payer advocates eventually have their day, it will be heavily influenced by the public’s demand for meaningful info. Sometimes my colleagues grouse about online doctors’ ratings. Here’s my advice to them: get used to it.
2. The Patient Will Pay
Obamacare proposes a host of “free” services (mainly preventive tests and screening). While the concept is popular, here’s the reality: health costs are continuing to spiral. When we get around to bending the curve, it will require Americans to be more involved in payment.
3. Employer-based Health Coverage Will Fade
Rising out of the wage and price controls of World War II, employer-based health insurance is the way most of us have our coverage. But the concept is slowly but surely fading, with just 60% of all firms offering coverage (and just 46% of firms with under 10 workers). When Americans were born in a company town, went to work for that company, lived in the company houses, and then retired to the company pension, this all made sense. But with a mobile work-force, this type of coverage seems dated. That’s because it is.