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M. Susan Marquis, Melinda Beeuwkes Buntin, José J. Escarce, Kanika Kapur, Thomas A. Louis, and Jill M. Yegian Consumer Decision Making In The Individual Health Insurance Market Health Affairs, May/June 2006; 25(3): w226-w234. [Abstract] [Full Text] [PDF] [Erratum] [Reprints & Permissions]

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Health Policy Detente

Trapier K. Michael   ( 10 May 2006 )

Health Policy Detente 10 May 2006
Trapier K. Michael, Founder and President Marketplace.MD Send comment to journal: Re: Health Policy Detente trapier{at}gmail.com Trapier K. Michael	Susan Marquis and coauthors have completed a striking study of consumer decision making that affirms what consumer-driven doubters fear and advocates know: it is unlikely that contemporary HSAs, HDHPs, and CDHPs will eradicate uninsurance and unlock the puzzle of insurance market failure. But similarly striking is the health policy establishment's failure to acknowledge how consumer-driven health care, broadly conceived, is making medicine better for self-payers. Consider the non-risk burdens of a precarious pricing mechanism placed on self-payers by an industry obsession with the traditionally insured. Tompkins et al. claim that "billed charges can be perceived as shocking, or even punitive, to the uninsured"; shocking, because price negations are opaque to self-payers; punitive, because negotiations systematically ignore and therefore punish them.[1] What a relief, then, that account-based insurance plans have created consumer demands and political pressures for price transparencies and self-payer considerations; price transparencies, because account-based insurance will otherwise fail; self-payer considerations, because account expenditures are forms of self-payment. Now consider marketplace responses: the American Hospital Association has announced a pro-transparency policy; Healthia and Healthgrades are bringing hospital transparency solutions to market; SimpleCare is leading individual physician firms to eschew insurance and focus on self-payers; and MinuteClinic and RediClinic are franchising convenient, low-cost care clinics, compatible with self-payment.[2] Any viable health policy approach must address the uninsurance problem. But that problem is twofold: uninsurance is bad, and uninsurance is abundant. Traditional approaches underscore the later and distract from the former, while consumer-driven philosophies inversely stress the parlance of reform. Let me, then, float this détente: if the establishment will celebrate consumer-driven improvements regarding the self-payer plight, consumer-driven advocates will think more critically about the root causes of insurance market failure. Notes 1. C P Tompkins, S H Altman, E Eilat, "The Precarious Pricing System For Hospital Services," Health Affairs 25, no. 1 (2006): 45-56. 2. See http://www.aha.org/aha/members_only/content/04_27_06_trans.pdf; http://www.healthia.com; http://www.healthgrades.com; http://www.simplecare.com; http://www.minuteclinic.com; and http://www.rediclinic.com.