The Unintended Consequences of Good Intentions!

Another guest blog from Dr. Donald Kamens on the health-care exchanges- a personal experience.

Sometimes the symptoms of a disorder are the best clues about etiology.  In the case of healthcare insurance 2016, we have a disorder that is a horse, but not a zebra.  Why? Some would have you believe that rising costs are secondary to the high cost of emergency room care (zebra, or baloney, whichever seems more appropriate).  However, any individual not provided insurance by an employer, can try to buy coverage independently (or for a family member). Thereupon, the horse comes out of the barn.

So what is the breed of that horse?  Is it a Quarter-horse, an Andalusia, an Arabian?  No indeed.  That horse, is a Complexity-horse.  A tough breed, difficult to train. In fact the complexity here is so intense, that a new specialty has arisen:  the CAC (Certified Application Counselor).  Why?  Because applying for coverage is so complex that guidance, or counseling, is needed.  Well, it does not take a rocket scientist to figure out that if a system requires that it spend money for advisors to help hold the hands of applicants, something deeply internal is wrong.  The complexity is just too costly, in and of itself, regardless of the costs of care! What a conundrum!

Now, here’s a live example.  I have been trying to buy healthcare insurance for my wife. She left a teaching position several years ago to pursue other dreams, and that meant finding our own insurance plan.  In November 2016, that is so complex that the neighbors, many miles away, may well hear me screaming.  My years of working in this milieu, as a physician, as an administrator, and as a group principal, do not impact the sense of swimming through spaghetti.  Here are just some of the issues I ran into:

1.     The “marketplace” is impossible to discern.  Every state has its own pallet of availabilities, and within those, each company there is a bewildering spectrum of plans.  The website pages are impossible to read.  Even with page expansion on 36 inch screens, my wife even took pictures of me pouring over them with a magnifying reader.

2.     There is a proliferation of acronyms, incomprehensible terms, and head-scratcher delineations.  IF (and that is a big IF) one gets to see them, one has to do considerable deciphering.  DED means deductible; yes.  But then, you have to figure out and research many (many) others (e.g. PCY  ...per calendar year.  Something wrong with /yr.?). There are tons more.  And then, do you know what $1/$5/$15 means?  In some places (but not all) it means tier 1/tier 2/tier 3 drug costs. 

3.     The plan listings are in disorder.  For one company I was examining, there are bronze, silver, and gold plans. Fine, the idea is clear that gold is best, and so on.  But not so fast.  In this one, they are listed with bronze at the top, gold in the middle (though the costliest), and silver at the bottom being the only one with no drug deductible. What?

4.     The websites do not work very well.   Not uncommonly one gets bounced and has to start over, or some button does not work. Or worse, as on one site, things start acting crazy.  Here, it asked me the number applying for coverage [=1]. Then the number of people living under the same roof, including those not applying for coverage [=3]. Then it said “Sorry the number in your household does not correspond with the application number.” Seriously. Really.

5.     This is a mess!  Did I say that before?  The intentions of those who have set such things up, we have to believe, were good, even if modified by legitimate business concerns.  However, the outcome of this complexity is going to shoot the whole system in the foot. Or the head.

Worse than being a mess in just one state, think about setting up all these complex plans for 50 states! It has been no easy task. Nor was it free.  How much chemotherapy for a patient who could not afford treatment could this baloney have paid for?  I would estimate that if the amount spent on the complexity of the system were actually put into delivery of healthcare itself, the benefits to people would be immense.  This insurance mechanism is a waste of money, a waste of time.  And the real benefits to people are, I would venture to say, going to cause more problems than anyone needs.

Finally, here is my suggestion for an insurance application having five parts:

1.       Do I need health care coverage?  [  ] yes   [  ] no

2.       What is my income:  _____________

3.       How much can I afford per month per individual or per family for coverage?

[  ] $0 [  ] $10 [  ] $50 [  ] $100 [  ] $200 [  ] $500 [  ] $800 [  ] $_______

4.       Do I have any known illnesses requiring care? [list] _______________

5.       When do I want it to start? ____________________

Done!

In the past, when colleagues said they were leaving medicine because it was becoming more and more difficult to practice, I tended to think “wimp!”  Now I am myself thinking of leaving the country and finding a more rational solution to just being a citizen who might, or whose family might, need care someday.