Pesky Patients Asking Awkward Questions: Doc, Do I Really Need That?

A recent New York Times article lamented that employers are increasingly offering employee health plans that cover few medical expenses until a fairly high deductible has been met. About one-third of large employers offer only a high-deductible plan. Many other employers encourage enrollment in high-deductible plans by offering low employee contributions. As a result, more employees are covered by high-deductible plans and workers increasingly have to reach for their wallet before insurance kicks in. As news stories often do, the article used a tear-jerker of an anecdote to drive home its point. The subject of the story was Anita Maina. Although her monthly premiums were only $34 per month, her deductible was $6,000 and her health savings account not well-funded. Here’s the story:

Anita Maina was working on an arts and crafts project she found on Pinterest — creating a table out of wood and cork — when she ripped off a fingernail while removing staples from a piece of wood.

But she ultimately skipped the [office] visit since she had not met the $6,000 deductible on her health plan, and she knew she probably did not have much left in her health savings account…

The New York Times article even included a photo of Ms. Maina with her injured finger! es Whoa! What a dilemma! Not to downplay Ms. Maina’s misfortune, but if there was ever a medical condition that warranted patient discretion — it would probably be whether to spend $120 on an office visit to bandage a torn fingernail. A variety of health policy wonks weighed in on the issue. Paul Ginsburg explained that one approach to cost containment includes “…having a lot of skin in the game, or just having to pay for a lot of your health care.” Karen Pollitz (Kaiser) echoed Ginsburg’s concerns that patients can

be exposed to significant cost-sharing under high-deductible plans. Sara Collins (Commonwealth Fund) pointed out that it’s not the costs below the deductibles that drives health care spending. Frequent NCPA Health Policy Blog commenter, Princeton Professor Uwe Reinhardt, was also quoted. As one would expect, Prof. Reinhardt provided the only useful advice in the entire article! He explained there are firms that help patients in their quest for price information (e.g. Castlight, Healthcare Bluebook). But he cautioned that patients need to be careful to make sure providers will honor the prices that health care shoppers work so diligently to uncover. That’s good advice in any market. But it’s especially important in health care, where there is not one price, but dozens of different prices for the same service depending on who is paying the bill. My own observation: Shopping for medical care can be a little messy. But it’s not that hard. Moreover, it’s a necessary condition to control health care spending. It’s only the first step, however. Reference pricing is a tool some health plans are beginning to use to control spending above the deductible. But as more pesky patients begin asking their doctors awkward questions like “How much does that cost?” “Do I really need that MRI?” the process will become easier and clinics will be more upfront about prices. One important question patients always need to ask themselves: “Do I really need to see a doctor for a torn fingernail?”

Comments (8)

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  1. Devon Herrick says:

    If you are a reporter writing about worst-case cost-sharing scenarios, I would think you could find a better anecdote for your story than someone with a torn fingernail.

    In the process of writing the article, the reporter actually made a good case for why high-deductible plans are useful. I can almost hear Ms. Maina say… “If someone else had been paying the bill, I would have swung by the emergency room and had them bandage my finger. But since I was paying the bill, I grabbed a Band-Aid from the medicine cabinet.”

    • Ron Greiner says:

      Exactly, I will spend other people’s money all day long but if it’s my money then I’m more prudent.

      Over 60% of my HSA clients have a ZERO deductible on accidents. Then she wouldn’t have to think about the cost or drain her tax-free HSA.

      Also, they have a ZERO deductible on heart attack, cancer, stroke or other covered Critical Illness.

      Of course most HSA coverage has ZERO deductible on preventative and annual physicals now. We had to do this for the whiners of the world. Of course it makes the premium go up but Liberals never worry about that. A self-employed guy won’t go to the doctor even if it is free, he just pays for it now.

  2. Ron Greiner says:

    Somebody should have explained to this young woman’s employer that when you put a dollar on her paycheck the employer is taxed to the max and is paying payroll tax, workers’s comp and unemployment tax. On the other hand when the employer puts a dollar in her tax free HSA — there are no taxes.

    Abracadabra, no taxes. We are talking compensation without taxation!

    I wrote about this 8 years ago but of course nobody ever pays attention to me. I might not know much about stocks but I have a handle on the tax-free HSA.

    My writing is now gone but this guy at RedState saw it and re-posted it.

  3. Ron Greiner says:

    Devon, I read this post to Pam because I knew she wouldn’t read it. So now she has been exposed to 2 posts from the NCPA Blog. I did show her that heart breaking picture. She is a woman of few words, she said:

    “It worked exactly as intended.”

    People who want the classy tax-free HSA watch this 1 minute video. My good friend Manny is a VP there.

  4. Bob Hertz says:

    Question for Ron (or anyone else):

    Why don’t the ACA insurance plans have a zero deductible for accidents?

    Is that because of relentless political pressure to keep premiums low?

    Health insurance has tons of mandates already, but why not accidents as a mandate?

    • Ron Greiner says:

      Bob, we don’t need any more mandates. It used to be that you could get SuiteSolutions: Helps pay out-of-pocket costs associated with accidents (ZERO deductible) and life-threatening illnesses, provides benefits for accidental death, dismemberment and disability and offers many other benefits all for $50/month for the whole family. It’s not available anymore but these goofballs still have the info online:

      Today, there are a lot more choices and it would take forever to try and explain it to the consumer. Today, TIME is smart, and the accident benefit has 2 levels, $100 deductible and $250 deductible. The cost for you, same price for any age, on level 1 is $9.70/month assuming you are an office worker and not a construction worker. If you want to see what is now available follow this link and request an online quote and too many options are available.

      TIME makes everything available including dental that I would never sell. I would tell a client to put that money into their tax-free HSA instead. TIME’s Critical Illness for their uninformed agents is OK but there is a much better way to get it and that is a rider on Life Insurance which of course still has medical underwriting – that’s why the premiums are so inexpensive. It’s smart to have a smart agent. I’m not smart on Life Insurance but my partner is and I just do what he says.

      TIME is ahead of everybody with technology. Obama should of had TIME do and I’m sure it would have worked the 1st TIME and they would have done it for FREE.

    • John R. Graham says:

      I expect you are right: Accidents are expensive so first-dollar coverage would increase premiums. Annual preventive check-ups are inexpensive and predictable.

  5. Big Truck Joe says:

    I agree with Devon- couldn’t the writer have found a more poignant example? That story and the patient’s “condition” passes for journalism!? Did anyone edit that example before it got published? What – did they think she had gangrene? Oy vey, this type of agenda journalism makes me mad.