Plan Design and High Deductibles
In the recent article which addresses the issue of plan design and high deductibles, it is predicted that over 50% of companies in the future will be offering high deductible plans. It also mentions that Accountable Care Organizations (ACO) feels that the consumer is not using medical services or they are delaying those services as a result of high deductibles.
The fact is during these last several years middle-class Americans must decide what is important, the food on the table, the mortgage, the car, or insurance payments. Once they meet all of these expenses it becomes difficult to meet the high deductible. Once the need for medical attention is apparent, the decision of what facility to receive treatment is decided by who will not ask for payment of the deductible. In almost all cases that is the emergency room (ER). This is mostly because all other medical facilities and physician offices will not treat the patient without them meeting the deductible. The problem is amplified, since the physician exam is never sufficient without the blood test required to make an accurate diagnosis. So even if the consumer pays the physician office fees, they cannot pay the high lab testing fees. Therefore the ER is the best option for care which includes a physician and testing. Since treatment is assured in the ER the consumer cannot be released until vital signs are normal.
The idea that the fee for service is the only effective distribution of care, and buying insurance policies is the only method of distributing healthcare to the consumer is why we are facing these dilemmas. While it’s important to have insurance to protect the consumer for catastrophic illness, do we need to continue paying for deductibles that are over $1000 to cover 80% of the basic medical services that most people want and need? The reality is the consumer is paying all the basic services since those testing and physician fees do not ever meet the deductible.
Since the majority of consumers go to the ER, then should there not be facilities that provide the same services as an ER, without the emergency? I call these center Life Resource Centers which provide services as the current hospital, medical facilities, or physician offices, plus much more, with the exception to meet the deductible prior to services. This is an alternative to how we distribute the care the way consumers need and want. The idea of getting care when needed without the nightmare associated with deductibles is what consumers have been asking for. The middle class wants to contribute and support any law which improves the quality of care and makes services available, yet 80% of middle-class Americans never reach their deductible currently.
The question is does it always have to be under this maze of the current fee for service system, where we pay a premium, pay deductibles, and continue the dilemma as to where we go for care?
