Saturday, August 01, 2009

Why I Worry, Health Insurance Edition

Take a minute to let this press release from Rep. Cary Condotta wash over you:
"Let's get back to true insurance instead of prepaid health care. It worked before and it will work again," said Condotta. "Now if we could just make Health Savings Accounts available to all state employees, as is required under House Bill 1383 signed into law in 2006. This type of option could actually reduce costs and premiums for all plans. Now is the time for bold action to reverse the perverse cost increases in health care caused by low deductibles and co-pays. Steve Hill and the board have taken the first step, now let's get the HSA option in place and watch health care costs decline and people's health improve accordingly."
Get that? $15 co-pays and $100 deductibles are THE PROBLEM, and Rep. Condotta has a solution: health savings accounts! Never mind that there's ample evidence that HSAs make existing systemic problems even worse. Marguerite Roza of the University of Washington has written before about the "above average" health insurance that teachers receive, the clear implication being that we're getting something we haven't earned and that something should be done about it.

I carry the insurance load for my family. My wife is self-employed, and with my special needs daughter in the picture I'm a power user of our Group Health plan. This year I've paid $442.86 a month, and next year preliminary estimates say that it'll be more like $470. I also put $100 a month into an American Fiduciary flexible spending account, and I'll easily use all $1,200 of it before the year is done.

Granted, I'm not typical. Single employees, employees who are covered by their spouses, and employees with no kids in the home usually end up contributing to the insurance pool that gets split up among people like me who pay out-of-pocket. If you cover your family a proposal like Rep. Condotta's screws you over twice, when your rates go up AND there's less of a pool to help you out.

The problem that's been identified by everyone is the cost to the system. Any solution that relies on making things harder for teachers isn't a solution that deserves to go anywhere.

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Blogger Dr Pezz said...

From personal experience I can tell you that Condotta is a mental midget who tows the party line and who reads from the party buzz words bulletins verbatim. He still wonders where the sun goes at night.

9:44 PM  
Anonymous Anonymous said...

Hmm. I read the "ample evidence" that the HCA-high deductible combo makes things worse.

I wasn't convinced it was evidence much less ample. One key point:

"There is considerable evidence that high out-of-pocket costs lead patients to decide against getting the health care they need."

This finding has another side: the evidence of the status quo patients deciding to get health care they don't need when someone else pays the bill.

The catch with both sides of this issue is who gets to decide the "need" and is does that decider have a financial interest to factor into the decision.

The other compelling information pertained to the debt resulting from paying high deductibles:

40 percent of privately insured adults with deductibles of $1,000 had problems paying medical bills or had accumulated medical debt, compared with 23 percent of adults with deductibles under $500.

Again, the other side of this evidence is that 60 percent appear to be OK with paying the out-of-pocket. I doubt this ratio differs from any other expense area--car payment, etc.

Ultimately the HCA approach works in the same way that welfare reform worked to motivate different, but more success-producing human behaviors.

Anyway, health care is a thorny issue rife with value issues beyond the ken of money, but it is axiomatic that what is free will be wastefully overused.

11:43 AM  
Blogger Ryan said...

Last commenter: You're reading "have a problem" in the Joe Pesci sense--"You got a problem with that?"--where I'm reading it in the "unable" sense, e.g., 40% are unable to keep up with their medical bills because of their high deductibles.

9:37 AM  

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