Wednesday, March 23, 2005

Healthcare Rant

This afternoon I came across a memo about a seminar that's going on in the area here in mid-April regarding containing health care costs. The seminar is geared towards corporate HR managers, not individuals.

On the agenda for the seminar are two major topics: high-deductible health plans, and "minimizing utilization through expanded wellness initiatives".

Regarding the former, the presenter of the seminar comes from a company which supposedly had a "successful" experience with the high-deductible health plan idea. Of course this stuff makes me nervous. The big problem with the high-deductible plan, as well as any plan which tries to decrease utilization through increasing per-usage expenses for the subscriber, is that it hits the lower-income employees so much harder than the bosses. My boss makes much more than I do, and so I imagine he would be able to handle a $1000 deductible a lot more easily than I could. You run into the same problem with co-payments: if there's a mandatory $20 co-payment for each office visit, for instance, that would have a much larger impact on the lower-income staff. So when they say they had a "successful" experience with the high-deductible plan, I have a lot of doubt whether their front-line grunt employees would see it the same way. Of course, what do corporate HR managers care about the front-line grunts? The worst part of this is that industry trends that screw over the grunts eventually have an impact on employers like mine, where they actually do give a shit about the grunts. Our boss has a difficult time every year at budget time dealing with the suits on the board of directors, who maintain that "everyone else is increasing so and so, why can't you do it as well?" (As if "everyone else is doing it" has ever been a valid excuse for anything--remember how the teacher would respond to that when you were a kid? I thought so.)

As for "minimizing utilization through wellness initiatives"--heh. That's a little bit of doublespeak that would make Orwell proud. Of course there are some "wellness initiatives" which can strictly benefit the staff, such as discounts on YMCA memberships, for example. But what about charging higher premiums to smokers? Or to obese people? Or simply not hiring these people in the first place?

Wellness initiatives can backfire, too. Joe Schmoe signs up for the new discounted YMCA membership and then blows his knees out on the treadmill. He ends up needing surgery. How does that reduce healthcare costs for the employer?

In general, I agree with the idea of reducing the role of employer-sponsored plans in American healthcare (primarily because the dependence on employer-sponsored plans gives an unfair competitive advantage to large corporate employers), but the slow evolutionary way that it's happening is succeeding admirably in screwing people rather than really solving anything.


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