It might be reasonable to assert that we are about to develop a tension point in the United States in the delivery and financing of health care services. This tension point will not be between rich and poor, nor will it be between residents of urban areas or rural communities, nor between those who finance their health care through their employer or buy it individually through the private market.
The tension point I am describing will be between those with high-deductible health insurance plans and those with low-deductible plans. Let’s be clear: Deductibles have been used in many forms of insurance to restrain excessive use of whatever service the insurance product is designed to protect. Auto insurance deductibles, for instance, have the benefit of causing the insured to act with prudence and restraint because that individual must pay out of pocket the first level of expense to repair their automobile. Theoretically, they have “skin in the game” and thus act rationally and prudently in how they finance their car repairs after an accident.
The size of the individual customer’s deductible could, in fact, influence our future health care delivery system. Historically, in the United States, deductibles for health insurance have been relatively modest. I can remember when I first started as a health care executive: $50 deductibles on insurance plans were commonplace. Now, several decades later, $1,000 to several thousand dollars are routine.
Individuals with low deductibles bear little economic consequence for their decisions in the purchase of health care services. They have little incentive to search out the lowest price for any particular health care service and, as a consequence, ask relatively few questions of their physician. When a particular diagnostic test or treatment regime is suggested to a high-deductible plan user, it has the opposite effect while in turn causing premiums to fall as deductibles increase.
If we all were prudent buyers and if we all had the discipline to set aside several thousand dollars (perhaps through a health savings account) and purchase a health insurance policy with a large deductible, that would prove to be the most logical way to purchase health insurance. In other words, we insure against the high cost of health care services by taking the risk for low-end cost. When we do this, we suddenly become much more aware of the nuances of our decisions in the acquisition of health care services. We begin to ask questions that would never occur to us if we had a small or negligible deductible. We, for instance, would likely question our doctor’s recommendation to seek care for a high-cost service when the internet tells us there are lower-priced options available. We might even be stimulated to ask more penetrating questions of our physician relative to the treatment options themselves.
In our search for what rules an ABC partnership may break, perhaps one of the most penetrating would be our desire for lower deductibles.