Appealing when presented in the abstract, but I have nightmarish visions of such a system.
On the one hand, you'd further motivate those consumers who were already likely to avoid preventive care and ignore symptoms until they require costly (to me as contributor to the catastrophic plan) emergency and intensive care. And the author's position that folks would be able to withdraw funds that exceed a certain ceiling adds the perverse incentive to risk not spending this money, with the downside being absorbed by the catastrophic plan.
On the other hand, you'd do nothing to discourage consumers with irrational fears about their health from distorting prices upwards, or to discourage unscrupulous providers from fomenting those fears. The plan he describes takes fee-for-service and all its problems to a whole new level. I think of things like the celebrity anti-vaccine mess and the healthcare debate with its distorted media coverage and disingenuous advertising, and I have hard time accepting a consumer-driven market succeeding, even with all the government-collected and -analyzed data in the world.
Even worse, I fear that such a system would result in a tiered system, where the best and brightest providers provide excessive care to those with means while the rest of us continue to struggle with barely adequate, barely affordable care.
I don't think that any system that relies on healthcare consumers making the choice between limiting their usage of healthcare services and spending money is destined for success. Providers need to be rewarded for providing the best outcomes for the lowest cost with the fewest mistakes, not the most and most expensive services. Significant efforts must be made to improve the public health of Americans. The conversation should be about how to make those things happen. All this debate about who pays when is just a side show that is obstructing real reform.
Your fears are ones that one could have about any market. But in general, free markets seem to work better than any of the alternatives across a wide range of markets, and I really doubt that health care would prove an exception to this.
It won't be perfect, of course, but a perfect system doesn't exist. I'm absolutely appalled that I'm paying (on average, as an American) over $1.5 million over my life for the present system, and can't imagine this would remain the case if pricing and outcome transparency were drastically increased. I think that quality and service would improve, while cost would decrease.
You're making the somewhat curious assumption that systematic neglect of "preventive" care (i.e. routine checkups) results directly in the "downside": large-scale, high-cost catastrophic events.
It certainly can, but from the point of view of statistics in human pathology, a complete non sequitur. For every person that neglects a checkup and misses early detection of a highly surreptitious, life-threatening disease, there will be ten for whom it either has no impact or results in low-grade, unremarkable chronic conditions that require occasional office visits and prescriptions.
Having to directly bear the cost of going to the doctor also provides a considerable incentive for leading a healthier life and staying away from bad habits with adverse medical consequences, in the same way that people are disincentivised to do avoidable things that hurt their financial standing in other areas.
Yeah. It's the same way with auto insurance and warranties. The dealer covers the costs of any catastrophic maintainence for the first few years, so the consumer tends to skip out on routine maintainence like oil changes. And at those regular tune-ups, when the mechanics appraise someone of a developing problem, they tend to avoid preventative maintainence, saying, "Nah, I'll just let it fail so the warranty handles it."
. . . ;)
My theory is that the inconvenience of a major failure and the risk to life and limb are much more important to most folks than the tiny costs associated with regular and preventative maintainence. I know they're more important to me!
It's actually been rigorously shown to work the same way with medicine. There was a study on HSA / High Deductable plans already in use, and it found that use of preventative care actually increased compared to the baseline.
On the one hand, you'd further motivate those consumers who were already likely to avoid preventive care and ignore symptoms until they require costly (to me as contributor to the catastrophic plan) emergency and intensive care. And the author's position that folks would be able to withdraw funds that exceed a certain ceiling adds the perverse incentive to risk not spending this money, with the downside being absorbed by the catastrophic plan.
On the other hand, you'd do nothing to discourage consumers with irrational fears about their health from distorting prices upwards, or to discourage unscrupulous providers from fomenting those fears. The plan he describes takes fee-for-service and all its problems to a whole new level. I think of things like the celebrity anti-vaccine mess and the healthcare debate with its distorted media coverage and disingenuous advertising, and I have hard time accepting a consumer-driven market succeeding, even with all the government-collected and -analyzed data in the world.
Even worse, I fear that such a system would result in a tiered system, where the best and brightest providers provide excessive care to those with means while the rest of us continue to struggle with barely adequate, barely affordable care.
I don't think that any system that relies on healthcare consumers making the choice between limiting their usage of healthcare services and spending money is destined for success. Providers need to be rewarded for providing the best outcomes for the lowest cost with the fewest mistakes, not the most and most expensive services. Significant efforts must be made to improve the public health of Americans. The conversation should be about how to make those things happen. All this debate about who pays when is just a side show that is obstructing real reform.