07 February 2016

Deductive Reasoning

Among the most interesting, if heinous, ideas of the 1% is that healthcare is just another consumption good, and if "we" make it more expensive, then people will spend less on healthcare. And the rich will get richer, of course. The notion, of course, is nonsense. Only the 1% could ever afford tummy tucks and silicone boobs and such. The rest of us only seek healthcare when something bad happens. There have been studies (you can find them, if you're interested) which find that preventative healthcare makes no difference to overall health of a population. That should be obvious: how many health problems do you know of that show up in an annual (or biannual) physical? Vanishingly few.

One of the core ideas of the save-money-by-making-healthcare-expensive is high deductible plans. Again, the notion that such plans are both less expensive and offer better health is grounded in the notion that the 99% are visiting doctors like corner ice cream shops. Of course not. Sure, there are a few hypochondriacs, but the gross effect is to deny vital healthcare when it's a matter of life or mortality/morbidity.

Today is a report on a study bringing some data to the issue. I expect you'll find it illuminating.
The hospital offering the $3,000 M.R.I. might lose enough business that it will lower its price.

I picked that particular sentence, since The Tyranny of Average Cost™ is generally couched in terms of what happens to the price of MRI scans if far fewer are done. The notion that MRI scans are highly price elastic makes no sense: the cost is almost entirely amortization of the machinery. There's not much else to pay for. Fewer MRIs at $3,000 mean that the MRI scan now costs $4,000 or $5,000, depending on how many are removed from the accounting.

Anyway, a large, unnamed company instituted a high deductible plan, and was followed by some academic researchers.
Amitabh Chandra, an economist at Harvard, and one of the researchers, said he was convinced the study would prove the value of deductibles, at least for well-off and well-educated workers.

He was wrong.
Mr. Chandra said he was no longer convinced that deductibles turned patients into good consumers. "The best case was the theoretical case," he said. "I was all for high-deductible plans before I wrote my paper."

And, of course, the punchline is stated explicitly:
"There's essentially nothing they can do to prevent the likelihood they'll have high-cost health events," [Dr. Peter B. Bach] said.

Well, just die early. Which is the whole point, of course.

1 comment:

Adam Bradley said...

...a working paper on what happened when a large (unnamed) employer switched from a more generous health plan to one with a high deductible. The typical worker in the company was young and Internet savvy, and earned more than $125,000 a year. The company gave employees a web tool to compare health care prices, and a health savings account for the full amount of the deductible, so they wouldn’t actually have to pay any bills out of their salaries.

Do healthcare economists follow a special curriculum that includes no mention of the concept that other commodities than money (time, for instance) have value? The way I understand this study (there was a longer description on Vox a few weeks back), these workers went from a plan where a visit to the doctor cost $0, plus the time it took to go to the doctor; to a plan where a visit to the doctor cost $0 (net), plus the time it takes to go to the doctor, plus the time it takes to use this "web tool to compare health care prices", plus the time it takes to manage an HSA (a new bank account they didn't have before, of a specialized type you've probably never heard of if you don't have one). The cost of healthcare for these people shot up dramatically--probably more than doubled--and a Harvard economist was surprised that demand went down.

And another thing while I'm ranting: Note that HSAs work differently to FSAs. You don't lose the money left in your HSA at the end of the year. Optum Bank (the company that administers mine) markets them as a kind of adjunct retirement plan--be stingy with your healthcare spending now, and you'll have money left over for those Medicare supplement premiums later on. You can even invest that money to earn returns on it (HSAs don't seem to pay interest as far as I can tell). That gives you a strong incentive not to use your HSA: spending that money is like taking a withdrawal from your 401(k).

The closing paragraph is just beautiful: "Some health economists say the solution to the problem may be smarter but more complicated forms of health insurance." Yes, obviously the problem is that it doesn't take enough time to figure out your health insurance.