The Myth of Consumer-Directed Care


Originally published 1/13/11 on Health Populi

The theory behind “consumer-driven health care” is that when the health care user has more financial ‘skin in the game,’ they’ll become more informed and effective purchasers of health care for themselves and their families. That theory hasn’t translated into practice, based on data from the Employee Benefits Research Institute’s (EBRI) latest Consumer Engagement in Health Care Survey.

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Will Consumerism Save Health Care


Originally published 2/27/06 on The Health Care Blog

Note: Jane’s report, above, on the ideological conceit that higher deductibles makes for more careful health care purchasers, reminded me that I dove into the topic early on, and pointed out the ramifications for the chronically ill and low income patients. The idea was cooked up by the conservative John Goodman of the National Center for Policy Analysis – his blog boasts that he is the “Father of Health Savings Accounts – and then spread by the right, with the wholesale enthusiasm of health plans. The irony is that we’ve learned since that high deductible health plans can work well, but they need to be provided in concert with free (or nearly free) comprehensive primary care, with the HSA dollars conserved so they’re available for more serious conditions. Here’s what I wrote five years ago.

In January’s State of the Union Address, President Bush called for expanding Health Savings Accounts (HSAs) as one sensible approach to curb rising healthcare costs. An HSA is a tax-favored healthcare-dedicated savings account that a patient controls. Combined with out-of-pocket requirements and a High Deductible (also called “Consumer Directed”) Health Plan (HDHP), these financing devices can provide comprehensive coverage. Federal 2006 HDHP family coverage guidelines call for deductibles of at least $2,100, with maximum out-of-pocket expenses of $10,500. To his credit, the President also proposed tax changes that would give individuals the same advantages employers already enjoy when they buy health insurance.
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