What does 'protecting choices in health reform' really mean for us?

(This post comes from Uwe Reinhardt, a health economist at Princeton University, who spoke at a press briefing last week, Consumer Choice in Health Care: How Could Reform Affect Our Choices? How Could We Make Better Choices? The briefing was sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation. To view a webcast of the briefing, click here.)

In comparison to people in other countries, including my native Germany, Americans place much more value in having choices in health care. But they don’t do a great job of explaining what they mean by choice.  The way I see it, there are three main categories of choice in health care: 1) choice of health insurance plans 2) choice of providers and hospitals and 3) choice of treatments and therapies.

Lots of attention is paid to #2 and #3, but in some ways choice of insurance plan dictates our current level of choice more than anything else.  It seems bizarre to me that the U.S. health care system is set up so that your health insurance plan dictates what doctors you can see and what treatments or therapies will be covered. We are essentially telling people, “You can have this choice, but once you choose your health insurance plan, you will have less choice of doctors and treatments.”

I wonder how many Americans lie awake in bed at 3 a.m. worrying about their health insurance plan. I’d venture to guess not nearly as many as those who worry about being able to choose their doctors and, in consultation with doctors, their treatments. Canada, Germany, Switzerland and many other industrialized countries allow you to choose your doctors, regardless of what kind of health insurance you have.

When it comes to choosing treatments and therapies, however, there is a point at which there are so many choices that they can paralyze you. The current U.S. health care system is analogous to a retail customer being blindfolded, pushed into Macy’s and told to “choose” which items he or she would like to purchase, not knowing the price or quality of the products. Hopefully, health reform will provide health consumers with the information that allows them to take the blindfold off and know what they are purchasing.

But choice is a luxury that has a price. How much are Americans willing to pay for health care? If you look at the Milliman Medical Index, health care now costs an average family of four $16,700 a year and will increase to $18,000 next year. If this trend continues, ten years from now, a family of four will need to plan on spending $36,000 a year for health care alone, nevermind college tuition, taxes, social security, etc.

I hope that health reform will help inform Americans how much health care really costs and what they are getting for their money. Then they might make different, more informed choices about their health care.

Comments

[Margaret Wallhagen]

I fully agree with what Dr. Reinhardt said in his commentary. Rationing of health care occurs all the time and choice is an allusion; we're limited by where we live and what is available as well as what is covered. We also do not want to make difficult choices in the face of limited resources. However, panel participants kept talking about more information and more "informed choices" when health literacy is often less than optimal, even in those with a lot of education, and the ability of many individuals to make sense of the confusing array of information is extremely limited. Further, as Dr. Reinhardt noted, too much choice can create a great deal of anxiety; we do not always want to be in control.

[Jacob Silver]

Part of the problem is that some opponents of national health insurance spread disinformtion alleging national health care will restrict choice of who one may see. This spreads some anxiety among the public.

Another factor affecting choice is the concern of many physicians about malpractice suits, who therefore engage expensive tests and procedures, often without providing the patient with a choice of doing so. Generally, choice is quite restricted with respect to treatment. If one wants a particular type of treatment, one needs to select a particular type of practitioner. But not many types of practitioner are covered by insurance, public or private. So choice is restricted there also.

[rey]

The main problem I see in the USA is the belief in health care reform. You can reform what does not exist.

USA "health care" is nothing more than a money transfer machine which does next to nothing. The entire system is designed around the concept of making sure very few problems are actually resolved for the patient. It is the business of keeping people sick so they keep paying you.

This is the big business ideal for health care. The greatest fear they have is one might get better and not come back. The is the reason for all the misinformation and lies.

The idiots who chant "health care is not a right" are the fools who only understand what they are told and stop there. Yes, "health care is not a right" --- it is a NECESSITY! Would you accept a similar concept of food insurance? Really, my idea has very low deductibles. Like eye/hearing/dental care, you would need another policy for vegetables.

The problem will be fixed when EVERYONE who is not rich has a death in the family due to insurance problems.

I recently saw someone speak who was a conservative at a democratic healt fair rally. She suddenly found herself not able to get insurance due to pre-existing conditions. Suddenly she understands what the problems are. What do you think she was thinking in the 90s? Could it have neen "health care is not a right" along with the rest of the dittoheads?

People like this can only understand a problem when it affects them personally.

[B. Diller]

what choice does anyone have without money,ore insurance that does not happen to cover whatever one did not know they needed when they purchased insurance and ended up getting ill,had an accident, (how does one know what to insure for,) that was not covered i do not understand that there is resistance to universal coverage,ore is there resistance ,from hearing and talking with,people,it appears it is the insurance companies and the,politions been sponsered by the insurance and drug lobby