A Kaiser Family Foundation study released earlier this week revealed nearly half of the 2,500 adults surveyed reported “some kind of problem with their health plan.” This, despite the rash of new laws recently enacted to “protect” the consumer as well as the industry’s own efforts to become more consumer friendly.
The good news is that for the vast majority of these individuals the “problem” did not directly affect their health. Instead, they were frustrated with the “system,” or, as the study puts it, “more of a hassle than a horror story.”
Part of this frustration must be directly attributed to the lack of choices available to consumers. Most Americans under the age of 65 (which is where this survey focused) receive their health coverage through their employer.
The majority of those are small- to mid-size companies that generally offer only one “take it or leave it” health plan package. In these companies, employees have no say as to either their health plan carrier or their benefit level. More important, these employees are often forced to dissolve longstanding and trusted relationships because their doctor of choice is not part of the participating network.
There is a related problem as well. With employers paying the bulk of the health care premium, employees are sheltered from the true cost of their health care. This leads to little appreciation for what they are getting and no motivation to use health care resources wisely. What we have, therefore, are people joining health plans they haven’t chosen and receiving a service for which they are not equipped to judge its value. And we wonder why there is discontent?
How satisfied would consumers be with their car, for example, if they had no choice in make, model, or color? And how could they be expected to judge the value of leather interior or a surround-sound stereo if they couldn’t choose their preferences and pay accordingly? Can’t a society that gives people the freedom to choose their own car provide the same freedom for something as important as health coverage?
Fortunately, it can.
A developing trend in health care today is the emergence of the “health care mall” approach to employer-sponsored health plan benefits. This concept is becoming popular with employers and consumers alike because it recognizes a fundamental truth: Americans love choice.
In an employee choice health care mall, the employer sets a budget and defines the contribution they will make toward their employees’ health coverage. Employees then select from a wide range of competing health plans and varying benefit levels to find the one that best meets their individual family needs.
Employers love this because they know that by providing choice they will have a more satisfied work force. Employees win because they are empowered to make their own decisions and have the flexibility to select richer or leaner benefits commensurate with their families’ needs and budgets.
Is it better to have a plan with lower deductible or lower co-pay? Can I find a plan that features all of my family’s doctors, specialists and choice of hospitals? Am I satisfied with my health plan or should I change? Only the individual should make those decisions.
Let’s put the consumer exactly where he or she belongs , squarely in the middle of the health care purchasing equation. By providing freedom, information and empowerment it will become abundantly clear that consumers , not their employer or their health plan , are the ones ultimately responsible for the care they receive and the consequences of their choices.
Word is the co-founder and managing partner of CaliforniaChoice and is a former president of the California Association of Health Underwriters.
