The folks at Harvard really, really hate cost sharing (i.e., deductibles, coinsurance and co-pays) in health care. They are much less concerned about high premiums or taxes. At least that is the conclusion one might draw from a new article in Health Affairs.
The authors examined the fate of 393 families enrolled in high-deductible plans through Massachusetts’ Commonwealth Connector. The families were well off enough to be unsubsidized and enrolled in a Harvard Pilgrim health plan. These were compared to similar families in plans with no deductible. They were looking for –
…respondents’ reports of any financial burden, higher-than-expected out-of-pocket costs, or discussions of costs with doctors. To measure financial burden, we asked enrollees whether, in the prior twelve months in the Connector plan, they or a family member had had problems paying or had been unable to pay medical bills; had had to set up a payment plan with a hospital or doctor’s office; or had had trouble paying for other basic needs such as food, heat, and rent because of medical costs. An affirmative answer to any of these three questions was considered an indication of financial burden.
So right off the bat, the authors are judging that any discussion of costs with a doctor is a bad thing, and any “payment plan” is a “burden.” You can see where this is going. One might think that discussing costs with a doctor would be a good thing, but not to the folks at Harvard. And, by golly, using these criteria the researchers found that lots of folks are “burdened.” They write –
Among families in such plans, those with lower incomes, worse health, and more children were at greater risk for financial burden and higher-than-expected out-of-pocket costs. Families in high-deductible plans were also more likely to have higher-than-expected costs than were families in plans with no deductible.
The authors are remarkably unconcerned about what it would have cost these unsubsidized families to avoid such burdens. But they include a table that provides a hint ― if you compare the difference in annual premium to the annual deductible, as I do below. Gold plans have zero deductibles.
|Bronze Plan Premium||Gold Plan Premium||Difference||Maximum Bronze Deductible|
So families with “high deductibles” of $3,500 or less are “burdened” even though they would have to pay $7,190 in higher premiums to avoid the deductible. Keep in mind that the premium is lost money. The family would have to pay that every year no matter how little health care they consume. The deductible may not be paid at all in a given year, or a family may have to pay only a portion of it.
But our friends at Harvard have no trouble burdening families with very high premiums (or taxes) provided they don’t have to pay for any of the health care they actually consume or (heaven forbid) have a discussion with the doctor about the cost of the care he or she is providing.