[Mpls] SW Journal article on Minneapolis health care plan

[David Brauer]

Jeanne Massey writes:

> The City's new health care plan (profiled in the latest SW Journal)
> highlights the trend toward the privatization of health care.  <snip> a
> young, healthy  individual who is lucky enough to not have an accident in
a
> given insurance year, is likely to save money.

Jeanne's observation is generally right about such plans - just not the
city's.

Because the city puts a high percentage of its avoided share of insurance
premiums into employee medical-reimbursement accounts, NO employee would pay
more out of pocket over the course of a year. ALL would save money over
continuing status-quo insurance.

Jeanne is dead-on about a flaw of these plans generally: the worker accepts
far more risk, and for those who are older/less healthy, far more of the
cost.

> Advocates of this approach point to better consumer shopping and
> decision-making about health care services.  While I would love to have
more
> information on health services so that I could make more informed choices,
> this plan does not do this.

Blue Cross actually does claim to provide tools for this. Whether they work,
a city employee would have to comment. And why Blue Cross couldn't do this
for all plans, they have to comment.

But I will give you an illustration of this from my own life. My current
(high-premium, low-copay) insurance will shell out 80 percent of my
prescription drug costs. I have one prescription for which my share is about
$21 a month.

I am investigating switching to a plan similar to the city's (with NO
employer contribution, I might add, since I would leave the group). The plan
requires me to pay my first $4,200 a year of medical costs - but then it
pays 100 percent of everything. I would save $6,000 in premium costs - not a
hard decision.

Contemplating the switch - and that I WOULD have to shell out up to $4,200,
including for my prescription - I got on the Internet. Turns out there's a
generic equivalent of my drug that costs half as much.

I never asked my doctor for it because I had very little incentive. With
this newer insurance, I will. Over time, I would save out-of-pocket costs up
to my high deductible, and so would the insurer if they have to pay if my
medical bills top $4,200.

> The most serious flaw with the out-of-pocket plan (in exchange for low
> premiums) is that it is a deterrent to preventive care.  Individuals, and
> especially families with children, with a cost deterrent to receiving
> regular checkups and seeing the doctor promptly for a health concern, are
> less likely to receive early, proper attention and will suffer more down
the
> road, costing the system and consumer more, not less money.

Absolutely. But again, that's why the city did such a great job arranging
this plan - because the contributes a large amount into special Medical
Reimbursement costs, plus the monthly premium savings each family realizes
(making total savings higher than status-quo premium increases), the worker
have no excuse (other than greed) for not getting the medical care they
need.

For these people, I would change Jeanne's phrase from "less likely to
receive early, proper attention" to "less likely to seek early, proper
attention." It's on them.

Again, big disclaimer: for the type of low-premium high-deductible plan that
DOESN'T guarantee savings, Jeanne is 100 percent right; it's a cost-shift to
the sickest and least able to pay. People without savings - or without an
employer making big-time Medical Reimbursement Account contributions - will
almost certainly deny themselves care.

Jeanne is also 100 percent right about her criticism of our health system
not encouraging prevention. I wonder if there's a way to fuse a city type of
plan with one that also covers 100 percent of any preventative service.

I'd encourage city workers to post here about their experiences with the
plan, even though it is in its infancy.

David Brauer
Kingfield
Editor, Southwest Journal