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High-deductible health plans were supposed to encourage patients to shop around for the best deals. Instead, many face financial ruin. What went wrong?
Noam Levey, writes about national health care policy out of Washington, D.C., for the Los Angeles Times. (@NoamLevey)
His series for the Los Angeles Times is "Inside the high-deductible insurance revolution that is transforming U.S. healthcare."
Listen To Our Recent Conversations With Noam Levey On American Health Care
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Los Angeles Times: "Trying to shop for medical care? Lots of luck with that." — "Rebecca Grimm tried to be a smart shopper when her second pregnancy ended in a miscarriage last year.
"Grimm, who has a high-deductible health plan, first tried a $10 pill to clear the fetal tissue. When that didn’t work, she checked her insurance company website to compare the cost of a surgical procedure at several local medical centers.
"All were around $900, she recalled. Grimm went to a center a few miles from her house. The procedure took 20 minutes.
"The Grimms got a bill for $5,948.69.
"'We thought something had to be wrong,' said Grimm, who is 29 and lives in a small house in the northern suburbs of Indianapolis. 'Having a miscarriage was hard. Having to deal with medical bills for months afterwards was like salt in the wound.… It made no sense at all.'
"High-deductible health plans, which are fast becoming the dominant form of coverage for U.S. workers, were supposed to empower patients. Backers said the plans would create engaged shoppers who would check prices and compare providers, forcing hospitals, doctors and drugmakers to control costs.
"Deductibles have more than tripled over the last decade for people who get insurance through their jobs, but the promised consumer revolution never materialized. Instead, Americans have been left shopping in the dark and increasingly struggling with medical bills they can’t afford, a Times examination of job-based health insurance shows."
New York Times: "Shopping for Health Care Doesn't Work. So What Might?" — "Each year, for well over a decade, more people have faced higher health insurance deductibles. The theory goes like this: The more of your own money that you have to spend on health care, the more careful you will be — buying only necessary care, purging waste from the system.
"But that theory doesn’t fully mesh with reality: High deductibles aren’t working as intended.
"A body of research — including randomized studies — shows that people do in fact cut back on care when they have to spend more for it. The problem is that they don’t cut only wasteful care. They also forgo the necessary kind. This, too, is well documented, including with randomized studies.
"People don’t know what care they need, which is why they consult doctors. There’s nothing inherently wrong with relying on doctors for medical advice. They’re trained experts, after all. But it runs counter to the growing trend to encourage people to make their own judgments about which care, at what level of quality, is worth the price — in other words, to shop for care."
Kaiser Health News: "Groupons For Medical Treatment? Welcome To Today’s U.S. Health Care" — "Emory University medical fellow Dr. Nicole Herbst was shocked when she saw three patients who came in with abnormal results from chest CT scans they had bought on Groupon.
"Yes, Groupon — the online coupon mecca that also sells discounted fitness classes and foosball tables.
"Similar deals have shown up for various lung, heart and full-body scans across Atlanta, as well as in Oklahoma and California. Groupon also offers discount coupons for expectant parents looking for ultrasounds, sold as 'fetal memories.'
"While Herbst declined to comment for this story, her sentiments were shared widely by the medical community on social media. The concept of patients using Groupons to get discounted medical care elicited the typical stages of Twitter grief: anger, bargaining and acceptance that this is the medical system today in the United States.
"But, ultimately, the use of Groupon and other pricing tools is symptomatic of a health care market where patients desperately want a deal — or at least tools that better nail down their costs before they get care.
"'Whether or not a person may philosophically agree that medicine is a business, it is a market,' said Steven Howard, who runs Saint Louis University’s health administration program."
Stefano Kotsonis produced this hour for broadcast.
This program aired on September 26, 2019.
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