Dismal failure of health insurance


The whole point of health insurance is to protect people from the cost of direct medical care when unexpected illness strikes. But a recent survey by the New York Times, the Commonwealth Fund and the Harvard T.H. Chan School of Public Health of adults who either had a serious illness or were caring for someone who did reveals that health insurance fails in this regard. Namely, “ Among people with health insurance, more than 20 percent had trouble paying for basic necessities. More than a quarter had bills in collection, and 13 percent had borrowed money as a result of their illness.” Financial insecurity is the underlying theme of this piece. More than one third of those survey had spent all or most of their savings while sick, and 4% had declared bankruptcy. One underlying cause is that illness takes people out of the workforce. And so even with insurance, they don’t have the means to cover copays and deductibles, which have been steadily rising. Another theme is that respondents had no way of knowing what was in store for them: “They don’t know what their insurance covers.” And so when illness or injury strikes, they are rather helpless. “You’re kind of at a disadvantage as a consumer going against these big complicated systems that don’t always have your best interest at heart,” says Sarah Miller, an assistant professor at the University of Michigan who studies health insurance. One question is the role of providers in discussing the cost of care. “More than two-thirds of people in the survey said their doctors had never discussed the cost of their care.” Should they? At Zoom+Care we have found it counterproductive for providers to directly discuss prices and costs: the system is too complicated with too many variables and permutations. It really is the responsibility of the delivery system - whether clinic, hospital, network - to strive for simple, clear honest prices, that enable patients to assess value and tradeoffs. It is doable. That is the real “killer app”. But the establishment systems will fight this clarity and simplicity.


Read: New York Times: 1,495 Americans Describe the Financial Reality of Being Really Sick

Read: Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions

Read: New York Times: Getting Sick Can Be Really Expensive, Even for the Insured

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