The unstated assumptions

The WaPo writes up a RAND corporation study on consumer-directed health-care plans:

In contrast to traditional plans, in which beneficiaries typically pay a modest deductible and co-payments of $15 or $20 for visits to the doctor, the new plans can require consumers to shell out hundreds and sometimes thousands of dollars of their own money for drugs, doctors and hospital care before most coverage kicks in.

The annual deductible in a consumer-directed plan is generally $1,050 to $2,000 for individuals and $2,100 to $4,000 for families -- far higher than the average $220 deductible in a traditional employer-sponsored health plan. Premiums tend to be lower, however.

Consumer-directed plans have been heavily promoted by the Bush administration as a way to rein in spiraling health-care spending by giving consumers a financial incentive to shop around for the best care at a reasonable price -- and to get only the care they need.

Consumer-directed health care is just another corporate class caper to place the burdens of risk on individuals, in this case, using the shiny allure of low premiums to mask the shifting of the onus of financial responsibility onto the beneficiary.

The high deductible portends one of two things: a) you have the money to pay for treatments before your benefits kick in; or b) you are very judicious in your use of health services:

In some cases, for example, the greater cost-sharing burden on consumers meant that they did not go to the emergency room for problems that did not require it. At other times, people were forgoing necessary care and potentially jeopardizing their health.

I'm intrigued that making people "consume" their health care "responsibly" seems to be a stated rationale for pushing these types of insurance schemes. It suggests that the reason health care costs and insurance rates are so out of control is because people are going to the doctor too much. That and lawsuits (and hence the necessity for tort reform! But I digress...). That time you went to the doctor because you had a sore throat for three days and couldn't swallow, but the doc said it wasn't strep and you should just gargle warm salt water - irresponsible consumption of health care.

This is nuts. The driving force behind the increasing price of medical care is administrative costs. Preventative health care is more cost effective in the long-term than acute care. There are well-established links between access to health care and worker productivity. Why, then, is the solution to our health care crisis to discourage seeing doctors?

One of the great bogeymen of socialized medicine was the "rationing" of health care: hour long waits for doctors, 12-month queues for surgeries, a proscribed number of visits per year. Consumer-directed health-care plans accomplish a very similar goal in a neo-liberal context, forcing consumers to self-ration their own care. Funny how that works.