Thursday, January 19, 2012

Trying To Strangle Health Insurance Exchanges (HIEs)

Let's choose the health insurance channel!
A running joke among many managed care medical directors is that the typical enrollee spends hours comparing features and prices for their flat screen TVs and minutes selecting their health insurance.  Far too often, it's after enrollees get sick that they discover that many of their assumptions aren't meeting the reality of the provider network, coverage exclusions and out-of-pocket expenses that they chose

What's more, juicy anecdotes of failed enrollee expectations (such as unproven cancer treatments in cute bald children) have fueled advocates' demands for a generous version of reform (such as a single payer with a rich one-size-fits-all benefit design).

That's why the Disease Management Care Blog found this Kaiser Health News report interesting.  It raises two issues.

1. The Merits of Consumer Shopping.

According to the KHN report, what we're reading elsewhere isn't quite true because users of Massachesetts' health insurance exchange (HIE) are being flummoxed by a thicket of multiple insurance options with premiums that vary according to provider tiers (some hospitals will cost you more), out of pocket expenses (a.k.a "skin in the game" stuff like co-pays and co-insurance) and exclusions (some things are not covered).  As a result, a shopper can expect to spend "six to eight hours" selecting a plan!

The DMCB is shocked, shocked by the specter of consumers having to spend as much time comparison-shopping for health insurance as the typical amount of time used checking out Consumer Reports, scanning the newspapers for sales, seeing if Amazon has a better deal and driving to several electronics stores for that best flat screen, Blu-Ray player or speaker system.  Dammit, says the DMCB, buying health insurance is important and it deserves that much time.  If an HIE forces consumers to finally pay attention, the DMCB says that is a good thing.

As an aside, the DMCB also points out that the art and science of HIEs are still evolving.  With better informatics and user-friendly on-screen interfaces, it should get better.  Given government's heavy hand, however, the DMCB predicts HIEs will never match the astonishing slickness of parallel on-line consumer purchasing aids, such as smart iPhone appsTaxpayer consumer expectations will continue to not be exceeded.  They will be eventually met, however.

That being said, however, the Massachusetts experience also speaks to the naive assumptions underlying the Affordable Care Act's HIE provisions.  If that remains problematic, consumers will always have the option of letting D.C.'s Pete Stark, Max Baucus and Kathleen Sebelius save them time by arranging the details of their insurance for them.

2. Anecdotes and Framing

The underlying tone of the KHN piece vaguely suggests that consumerism and health insurance is a bad thing.  From the typical use of a selected negative anecdote, the skeptical visage of the person featured in the article, a "I could not figure it out" sub-headline, the sub-text portrayal of insurers as being intentionally opaque and the prominence given to saving money all paint a picture of a system that is failing. 

Good grief, HIEs have just gotten out of the crib and KHN's reporting suggests that the liberal and progressives still want to strangle this toddler.  Once again, the DMCB is shocked... shocked.


Ben Rush, MD said...

Why do we need government, federal or state, set up an exchange when we can already compare plans online?
Here's an example.

Van R Mayhall III said...

That's an excellent point about most consumers spending more time picking out an HDTV than picking out their health coverage. It seems like the question then becomes whether the government should be protecting us from our own bad choices.