Who says Consumer Directed Health Plans are Wrong?

I read a post by Rick Unger on Forbes.com today titled Consumer Driven Healthcare Proponents Finally Proven Wrong

And I tried to post a comment/reply but, for some reason, I couldn’t register – so I’m gonna post my reply to Rick Unger here.  This is a little off-topic from my usual ICD-10-related posts but I think it may be useful nonetheless.  Here was what I hoped to post on Forbes and what I did email to Rick Unger.  I welcome your comments.

= = = =
Rick

Of course “healthcare is not something that people will bargain for when seriously ill.”  Who's going to bargain when the chips are down?  It seems to me the key is for people to be aware of costs and to bargain when they are  holding some chips that others are hoping to earn/win from them.

In my opinion, your position that Consumer Directed Health Plans (CDHP) are an abject failure is way off the mark. You can’t possibly believe the population of Grand Junction, Colorado is representative of the entire U.S.? I suspect Grand Junction demographics are not even close to those of towns in Mississippi, Louisiana, Arkansas and many other states.  So, to me, your extrapolations seem suspect indeed; cherry-picking, or perhaps “reverse red-lining?” 

Moreover, you fail to address a few other important points:

1. People WILL and should bargain for healthcare services when they are not seriously ill, healthcare is elective (a want) or non-elective (a need) and should be differentiated as such. CDHP covers the preventative needs, governs the wants and protects against the needs of the seriously ill.

2. The high-deductible health plans characterizing CDHP contain strict provisions about coverage for the “preventative care” you argue for. Typically covered at 100% not subject to deductibles.  I believe that’s an IRS regulation for a qualified CDHP. So preventative services are not anathema to CDHP.

3. How do you argue that Grand Junction, Colorado health care consumers are representative of average American consumers?  I suspect that Grand Junction demographics are not even close to towns in Mississippi, Louisiana, and Arkansas.  How are you sure you’re extrapolation will work across the U.S.? Seems suspect and I say you’re cherry-picking? Or perhaps “reverse red-lining?” 

4. How would a dearth of PCP’s and local specialists impact your hypothesis?  (and that’s all you are really offering: anecdotal “evidence” and an educated guess that Consumer Directed Health Plans are a losing proposition)

5. How is it you think the physicians in the IPA you mention who “wish that patients on Medicare and Medicaid - not be treated differently than those with private insurance” are representative of the majority of doctors? Of course all physicians want the best for everyone. I suspect they also want to be paid for their efforts. Many doctors and health systems across the nation are abandoning Medicare and Medicaid enrollees due to low reimbursement levels and projected future cuts. 

6. Under the program you describe, what do you think will happen to the rates/premiums paid by private insurance customers who are subsidizing the others?  Ya think these private customers are going to be a sustainable revenue flow?

Some things I agree with you about – sort of - include:

1. Waste associated with end of life care.  [But that’s a real hot potatoe topic; especially for grandma and some who want it both ways.]

2. Physicians being subject to peer reviews where any proclivity to engage in procedures or tests of questionable value by a physician will be called out. [But that seems like a pipe dream – given current tort laws and a likely 'proclivity' for physicians to ‘protect their own.’]

3. Guaranteed pre-natal care, whether she has insurance or not. [Good idea]

In my opinion, you are selecting a microcosm of the U.S. healthcare population and extending those across the entire U.S.  Just doesn’t seem reasonable.

Steve S. (aka. ShimCode on Twitter)

.