For more than ten years employers have been pushing (today forcing) workers into high deductible health plans. Employers were told that one cause of high health care costs was a lack of concern on the part of patients; no skin in the game so to speak. After all, if you satisfied a modest deductible, why even think about future costs?
What high deductibles do, of course, is shift costs to the users of health care while lowering premiums for the majority of the insured population. There is a certain logic in that … until the deductible becomes a serious financial burden which is the situation now in many cases.
In 2015 this logic caught the attention of Congress and it passed the Medicare Access and CHIP Reauthorization Act. On or after January 1, 2020 Medigap plans that pay for the Part B deductible are not available to a newly eligible Medicare beneficiary. This includes Plan C and F. As you may suspect, C and F are typically the most expensive plans premium wise.
So, it seems clear to the people who foot most of the bills for health care that patients will care more about what they spend if they use more of their own money.
In 2019 that seems no longer true. The two major proposals from Sen Sanders and Rep. Pramila Jayapal for a universal health plan eliminate not only deductibles, but also cost sharing co-payments. It’s like no amount of money spent on health care should be part of one’s living expenses.
Why won’t removing any concern for costs encourage more use of services? Why won’t the vast majority of Americans pay more via taxes because of such a strategy?
Under this new philosophy about paying for health care, how will spending be managed? Keep in mind there are two components to these costs, the price of each service provided plus the number (and type) of services provided.