June 1, 2011
ObamaCare Makes Us Sicker and PoorerBy M. Catharine Evans
Major corporations, food retailers, and self-insured businesses are slapping whopping deductibles onto their employee medical benefits packages, converting them into catastrophic policies. The high-deductible health insurance plans are designed to lower costs by turning the "reactive" practice of medicine into a "proactive" one.
According to the Robert Wood Johnson Foundation's 2007 Chronic Care Model, a "reactive" medical situation might be described as an individual who notices an odd-shaped mole on her hand and immediately makes an appointment with her physician. In a "proactive" scenario, the patient, unable to pay the out-of-pocket cost for a doctor's visit because of a 2,000% increase in her deductible, prays the mole will disappear on its own.
In place of the comprehensive health care plans with minimal or no deductible, employers are building health/wellness packages designed to protect against catastrophes as opposed to routine care. Employees are exchanging lower deductions from their paychecks for higher medical deductibles, hoping they don't get sick.
The change to higher deductible plans has been dramatic. A March 2011 Rand study showed that in 2009 20% of Americans enrolled in employee sponsored health plans chose the higher deductible coverage. One year later that figure rose to 54%. The study also revealed that deductibles over $1,000 cut costs overall in the first year of enrollment. However, the Rand authors discovered that people with high deductible plans are less likely to get cancer screenings, immunizations, or regular physicals.
But we also found concerning reductions in use of preventive care. This suggests people are cutting both necessary and unnecessary care...and if this persists, it is likely to have health consequences in the future. These cutbacks could cause a spike in health care costs down the road if people end up sicker and need more-intensive treatment.
These "consumer-directed" high deductible plans will be the "key offering" when states set up insurance exchanges under the new heath care mandates scheduled to go into effect in 2014.
The alarming findings of the Rand study have some major employers brushing up on Skinnerian techniques of reward and punishment directed at their employees. Some businesses are reducing the amount of deductibles if their employees agree to a complete company physical, the results of which don't stay in the doctor's office, but end up in the employee's file. You could call it a "waiver for good behavior."
The shock and awe language used by the RWJ foundation in their Chronic Care Model, also cited by the Center for American Progress' 2008 600-page "Change for America," has employers frenetically attempting to modify the behavior of their workers.
The most recent data show that more than 145 million people, or almost half of all Americans, live with a chronic condition. That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. Almost half of all people with chronic illness have multiple conditions.
With incendiary and dubious statistics like these, no wonder employers who insure the majority of working Americans are pushing the panic buttons.
John Mackey, CEO of Whole Foods, who wrote a scathing rebuke of ObamaCare in an op-ed for the Wall Street Journal back in 2009, is trying to build a "culture of wellness" for his employees. In November of 2010 the so-called liberal magazine Mother Jones obtained a copy of a memo distributed to Whole Foods employees concerning the changes in their upcoming plans for 2011. Mackey used bold print in the memo to assure the team members the company was not raising premiums, but deductibles would rise and ObamaCare was responsible for the situation:
This is very important for everyone to understand. 100% of the increases in deductibles and out-of pocket-maximums in 2011 compared to 2010 are due to the new federal mandates and regulations. We are not raising premiums for 2011.
We are witnessing unprecedented changes in healthcare costs...as well as a very uncertain federal regulatory climate. It is impossible for the leadership of the company to know or predict ...what is going to happen to health care mandates, regulations or costs for the next several years.
This uncertainty facing large and small businesses, the lifeblood of a thriving free market system, faces everyday people as well. Why rush to the doctor with a cut that looks infected and pay over a hundred dollars to be seen? Many of us would just apply more Neosporin and wait it out. If it turns into a full blown staph infection we could end up in the ER with costlier complications. Where's the preventive component in this situation?
Dr. Donald Berwick, the Administrator for the Centers for Medicare and Medicaid Services (CMS), with his "person-centered" care systems suggests a patient should act as the physician's "peer" in determining treatment. In a NYT article entitled "Letting the Patient Call the Shots," Dr. Berwick, using his characteristic benevolent babble, suggests that physicians need to be relieved of the burden of having to "deny or exclude" patient care. Instead, he delegates the burden of changing the healthcare system to "leaders, the stewards, the people who create the organizations where the workforce works." For Berwick leaving his fellow doctors who trained for 12 years in charge is too "draining on the spirit."
Employers like John Mackey got the message. The ominous economic outlook has forced business leaders to go along with Dr. Berwick's systemic changes. The Whole Foods CEO wrote in his memo to employees:
...our doctors are trained in first aid, surgery, and in the use of prescription drugs. They are not trained in either healthy eating or healthy living and in many cases they know far less than many of their patients about these two essential criteria for wellness.
High deductible plans appear to be the only game in town for consumers with employer based insurance if they don't want to see their weekly paychecks dwindling even lower. That the plans complement the "person-centered" model touted by Berwick at CMS is a plus for the administration. Their popularity will help to achieve "a transformation of health care, from a system that is essentially reactive -- responding mainly when a person is sick -- to one that is proactive and focused on keeping a person as healthy as possible."
What's wrong with changing my diet and lifestyle to become healthier? Nothing, until my personal choices of what to eat and how to play are compromised by the threat of losing my job. When companies and the government get into the business of regulating what we eat in our own homes, we are no longer living in a free America.
Since many of us will now be paying premiums on top of all doctor's bills up to $2,000 per year, you would think there would be a bipartisan revolt. Not so. In fact Tom Scully, George W. Bush's director of CMS, praised Berwick in early May, saying, "I may not agree with him substantively on everything, but he's definitely doing a good job."
In addition to clueless people like Scully, we have million dollar nonprofits like the Catholic Health Association (CHA) barreling ahead with implementation of ObamaCare. The CHA, the same organization instrumental in pushing through the Patient Protection and Affordable Care Act, is sponsoring a major conference this weekend with keynote speakers Peter Orszag, former Obama OMB director and Dr. Donald Berwick. The 3-day assembly will host the leaders of major healthcare and insurance corporations discussing person-centered care and the necessity of "a new governance model in healthcare reform."
When will we the people get a say?
Read more M. Catharine Evans at Potter Williams Report.
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