A few years ago my son injured his arm in a soccer game. He broke one of the long bones as well as his scaphoid, one of the eight small bones that give the wrist such a wide range of motion. The scaphoid is notoriously difficult to heal because it has a limited blood supply. The risk here is that part of the scaphoid will die, causing severe arthritis months or years later.
The initial bill to diagnose and treat my son’s wrist came to just over a thousand dollars.
After he spent a month in a cast, we returned to the orthopedic surgeon’s office, where a physician’s assistant (PA) removed the cast and ordered a new x-ray. The scaphoid hadn’t healed completely. A new cast was placed.
We returned a month and another thousand dollars later, repeating the same procedure, with the same results. I knew we would receive the same bill.
I explained to the PA that we would happily pay the bill to be sure that our son had no long-term consequences from his injury. But I further explained that our insurance policy carried an eight thousand dollar deductible. Every time she removed the cast and took another x-ray we were on the hook for another grand.
She was visibly surprised by this information.
After a quick call to a consulting hand surgeon who viewed the x-rays online, our PA developed a new treatment plan. It kept the cast on longer before follow-up.
We’ve been living with this particular insurance plan since 2002. Never once have we met the deductible. I pray we never will. As long as we remain in relatively good health with the flu or a sports injury here and there, we’ll continue to pay for most of our bills out-of-pocket. Our insurance policy waits in the wings in case something more significant happens.
I think that’s a good thing.
Back in the old days, before my husband and I were self-employed, we had fantastic employer-provided insurance. I barely glanced at bills and documents after a medical visit. Why bother? I only had to pay our low deductible.
Now I scrutinize everything. I ask questions about our treatment. I double up on appointments when possible. Because I know that the costs are coming out of my pocket, I seriously consider them before I spend the money. I always mention our high deductible when we visit a doctor because they also change their approach based on how much it’s going to cost the patient.
Recently my son failed his athletic physical at a pharmacy clinic because his heart rate was too low (don’t get me started – seventeen year old boys who work out intensely tend to have a low heart rate). We went to our family doctor to follow-up, and my son was quickly cleared for sports. Upon learning of our deductible he asked if we wanted to take care of any other issues during the same office visit. We did and my son got a prescription for his acne before we left.
This is a great thing, and here’s why. No politician will admit it, and corporations will deny it, but healthcare rationing happens every single day.
Healthcare is rationed based on a patient’s ability to pay. I know a man who didn’t have insurance to afford surgical removal of a massive kidney stone. So he didn’t have the surgery and probably has some permanent damage in that kidney.
Insurance companies refuse to pay for treatments all the time.
The US Preventive Services Task Force (USPSTF) recommends screening tests. These recommendations (and non-recommendations) work their way into insurance policies. Even if a screening measure could save lives, it may not be recommended if the cost is too much to implement it on a large scale.
We all can’t have every test, treatment, or life-extending measure. The resources to pay for them don’t exist in individual pockets or in government coffers. So rationing happens.
High-deductible plans, if used well, give individuals the chance to ration their own healthcare instead of having it rationed for them.
Many who disagree with the idea of free college education state that students need to have some skin in the game to appreciate and take seriously the gift they are being given. It’s the same with healthcare. When we have skin in the game we are more likely to scrutinize our healthcare options. Then we can make fiscally sound healthcare choices for the short and long term.
There are two problems immediately obvious with the concept of implementing universal coverage with high deductible plans.
First, there are people who can’t come up with the money to pay a high deductible. They self-ration, often with terrible results. But, a policy can be made where those who cannot meet their deductibles can tap into other resources to cover these costs. Low interest loans and employer-sponsored programs come to mind.
Second, in order to avoid paying out-of-pocket, individuals might avoid basic preventive care or postpone addressing problems while they are small and manageable. In this scenario, individuals who get preventive care on schedule would be eligible for reduced premiums. And since everyone would pay out of pocket for this care, they might shop around a little, drive the prices down, and improve transparency – thus making it easier for everyone to afford it.
High-deductible policies across the board could help with the two biggest issues we have in healthcare – underuse and overuse of the system. No one wants to be the one to ration another’s access to healthcare. With high-deductible policies as the norm, we could do it for ourselves.