I’ve struggled for a long time with the idea of charging patients directly for payment. There’s just too much evidence that asking people to have “skin in the game” creates a serious negative pressure resulting in avoidance of needed care.
A recent article in the NYT points out the pitfalls of high deductible plans – the most worrisome pitfall is wealth of evidence showing that people avoid spending their dollars on care that might have prevented illness or allowed for earlier diagnosis and intervention.
So direct to consumer/”skin in the game” health care creates a financial hurdle to health care that too many people are unable to clear (and don’t tell me “they would clear the hurdle if they really cared” because the data just doesn’t support that statement – too large a swath of the population goes without needed care. To assume that that large a swath ‘just doesn’t care’ begs credulity).
On the other hand, ditching the insane costs, rationing, delays, and choice limits imposed by the insurance industry creates the capacity to practice highly ethical medicine for patients. Continuing to accept these outrageously harmful insurance company rules enables a broken and dysfunctional system to continue. Some (not all) of the coolest innovations in health care have been possible in practices that ditch the crushing yoke of insurance rules.
This is an awful situation. I want all Americans to have unfettered access to highly ethical high quality care. I know we as professionals want to deliver this care. Until the insurance industry is willing to stop blocking our work and actually support the outcomes we need, I just don’t see a way past this dilemma.