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I've Put My Family on a Health Insurance Experiment. It's Been a Challenge

I've Put My Family on a Health Insurance Experiment. It's Been a Challenge
From TIME - February 6, 2017

Enrollment in high-deductible health insurance plans has exploded over the past five years. Im learning the hard way how these plans doand do notwork.

About one-third of American workers covered by health insurance are now in high-deductible health plans, in which the policy holder pays a substantial portion of the cost of health care services out of pocket before insurance coverage kicks in. Many economists and health policy experts believe that these plans are a promising way to reduce health care spending.

So when a high-deductible plan became available through my employer, Harvard University, a couple years ago, I decided to enroll my family in it. If this is going to be a big national experiment, I thought that I, as a physician and a health policy scholar, ought to know what its like to live with this kind of health insurance. Debra, my wife, was not convinced.

While I am a proponent of experiments and evidence, Deb wasnt interested in including our kids in this one. The notion of having to think about shopping for health care if any of us got sick wasnt attractive to her. But if we stay healthy all year, I argued, we would actually come out financially ahead.

She reminded me that we have plenty of other reasons to stay healthy all year, and the potential financial savings didnt feel like a particularly compelling additional reason. Defeated by her logic, I turned to pleading.

I made the point that we had a lot of advantages in navigating the health care system effectively and that she and I should go about making the same health care decisions that we would have otherwise. She relented.

My family is now in its second year under a high-deductible plan. That means we are responsible for paying the first $6,000 of our health expenses for the year, for everything from a doctor visit for a flu shot to surgery.

It has been an educational enterprise.

Our experiment is showing me again and again that its extremely hard to be a health care consumer in Massachusettsjust as Im sure it is in other states. Want to know how much a particular type of health care costs, like a visit to a specialist or getting a minor surgery? Good luck figuring it out. My insurance companys online tool was hard to use and, even as a physician, I could almost never guess what sets of services a visit to the doctor might generate. Whats more, there was no useful information about the quality of care. Price information without quality information is not particularly helpful when shopping for medical care.

The second lesson was that being a health care consumer is stressful, at least the way the system is currently set up. Heres an example. Our son had surgery last year. We got a call saying it was time for his one-year follow-up. Deb stressed for nearly two months over whether or not to make the appointment. Of course she wants our son to get the care he needs, but did he truly need this follow-up? Thats both the promise and the peril of high-deductible plansthey are supposed to make you think twice about consuming health care.

She eventually went with our son for his one-year follow-upthey spent two minutes with the surgeonand paid $465 for the visit. Im not sure my son, or my spouse, felt any better afterward. There were many examples like this sprinkled throughout the year, but the most profound one was the one I experienced for myself.

I have supraventricular tachycardia, a common heart rhythm problem. When it hits, my heart races at about 180 beats per minute. It comes on a couple of times a year, lasts a few minutes, and usually isnt a big deal. But one morning I woke up with my heart racing. After 30 minutes, I wondered if I should go to the emergency department, knowing that Id probably get stuck with a multi-thousand-dollar bill. So I kept waiting. After an hour, during which my heart kept beating furiously, my chest started to hurt. I knew what that meantI was at risk of having a heart attack.

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