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.