Consumer, manage your medical savings account – high deductible health plan (HDHP)

Get ready for the rationing of health care in America.  It will fundamentally change the way we access health care.  But before writing a letter to your senator or calling your health insurer to complain, open your wallet and then take a good look in the mirror.  Getting the care we need and deserve will rely completely on our own ability to choose and spend wisely on medically necessary procedures and treatments.  We, not the government or the insurance companies, will be responsible for rationing our health care.

With escalating health care costs and no end in sight, the new catch phrase for cost containment is “consumer driven health plans.”  Companies save by purchasing less expensive and less comprehensive coverage, and with the extra money they set up health savings accounts (HSAs) and give us, not the insurance company, control of the funds to manage our own health care costs.

These accounts, strongly promoted by President Bush as reform, shift the financial risk completely to the consumer.  The thinking goes that when patients spend their own money on health care, they will become savvy consumers, decrease overuse and demand appropriate cost-effective treatments.  Already many consumers may have noticed more fiscal responsibility than in the past with rising deductibles, co-pays, and co-insurance cost sharing.

How prepared will we be to meet this new challenge?  Though as consumers we assess and purchase other goods and services daily, finding the relevant information for health care is not easy.  Research shows that Americans are not eager to switch to a system that makes them more accountable for their health care, but the economic reality is that employers cannot continue providing comprehensive health insurance.  A study by the Kaiser Family Foundation wonders if small employers (under 200 employees) will offer family coverage in the near future.  The government does not seem interested in truly reforming the health care system despite the glaring statistic that we spend more per capita than any other nation and yet cannot claim we live the longest.

And retirees aren’t immune either as employers are curtailing or dropping benefits entirely.  The mutual fund company Fidelity identifies health care costs as a major risk to retirement and estimates a couple retiring in 2004 needs $175,000 just to fund future out-of-pocket medical expenses.  For future retirees, the picture is bleak with predictions that health care costs will take up an amount equal to 20 percent of an earner’s pre-retirement income.

The next time your back aches and the sciatica flares up, you have to wonder, with your high-deductible insurance plan, what I can afford?  You can ignore the back pain and do nothing, see your primary care physician or seek care with a back specialist, a spine surgeon.

Either physician may recommend additional testing such as an X-ray, a CT scan or a MRI.  Since your insurance plan does not share the cost until your deductible is reached, did you save enough to pay for the doctors or any of these tests?  Your back pain could be a common low back strain or a slow growing cancer.

The challenges ahead are daunting.  What can you do?  Focus on prevention by exercising, quitting smoking and losing weight to stay healthy.  If you already have a diagnosis or problem, research the condition until you truly understand which treatments and options are appropriate.  Visit your doctor periodically to make sure you stay well.  Start saving money to cover your deductible so you never have to choose between your health and your finances.

Sadly, our health care system is shaping up to favor not the patients who need it most, but those with the knowledge and the finances to get medical care.  As a primary care physician, when I’m a patient, I’m ready for this new system.  Are you?  Welcome to rationing of U.S. health care in the 21st century.

(This is a reprint of the Opinion piece that appeared in the Sacramento Bee on Friday, November 12, 2004).