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February is Wise Health Care Consumer Month, says the American Institute of Preventative Medicine. But why?
The argument is that if more people become smarter health care shoppers, this by itself could “bend the curve” of our rising health care costs, slowing the rate at which costs increase. Too many people have been getting unnecessary diagnostic tests and treatments, it is said, which means more money spent on health care.
This is a particular concern this year, as the Affordable Care Act (called “Obamacare”) has finally gone into effect. By the end of January 2014, about 3 million Americans had enrolled in private insurance policies on the federal or state exchanges, and around 6 million had been added to Medicaid. Millions more are expected to obtain coverage over the next few months.
And when people can pay for their medical care, they do tend to buy more medical care.
Steps to becoming a wise health care consumer include finding the right regular doctor, whatever that means to you; asking questions about tests and treatments you are prescribed to be sure they are really necessary; keeping first aid supplies handy to avoid emergency room trips for things you could treat yourself. And, of course, take care of yourself — keep your weight down, stop smoking, get some exercise.
If we all did this, would it really make that much of a difference to our overall health care costs? Frankly, no one seems to know for sure. The big, heavy-duty expenses are for things like cancer treatment and heart surgery.
Still, “wise consumer” practices might save us something. In fact, there is a long-standing argument that people should have to pay more for medical care so that they make cost-conscious decisions. This is sometimes called the “skin in the game” theory.
A number of studies have shown that people with high-deductible plans do tend to spend less on health care. They are less likely to get treatments they don’t need, but they are also less likely to get treatments they do need, and they tend to skip valuable wellness services, like vaccinations for children. This is not necessarily going to save money in the long run, since putting off treatments until a disease gets worse makes it more expensive to cure.
Among the arguments offered in favor of the Affordable Care Act is that it provides for some no-copay preventative care, to encourage people to get diseases diagnosed and treated early. In theory, this should “bend the curve,” but there is no data yet showing us if this will work.
Also, it is hoped that the ACA will reduce emergency care usage. The American Institute of Preventative Medicine says, “The average cost of a visit to the doctor is about $199; a visit to the ER costs about $922, according to AHRQ” (Agency for Healthcare Research and Quality). A lot of ER visits are for problems that aren’t really emergencies and could be dealt with at a doctor’s office, so getting people to stop using emergency rooms for non-emergencies really ought to save money.
But then, who goes to an ER for non-emergencies? Typically, people without insurance do. In fact, in recent years politicians have been telling the uninsured to do exactly that in the mistaken belief that such care is “free.” It isn’t; it’s just that hospitals receiving Medicare and Medicaid funds are required by law to treat and stabilize acutely ill patients regardless of ability to pay. But somebody still has to pay for it.
For years hospitals have been making up for unpaid emergency room and other bills by adding surcharges to everyone else’s bills. And this in turn drives up the cost of health insurance premiums. A few years ago someone calculated that these surcharges added as much as a $1,000 a year to the average family insurance policy.
So, in theory, if people are able to pay for their own care in doctor’s offices, expensive over-use of emergency rooms should be reduced. However, there was a panic at the end of 2013 when an Oregon study found that expanding Medicaid caused more emergency room use. Oops! But if Massachusetts is our guide, this will be a temporary effect. When Massachusetts expanded health care coverage a few years ago, emergency room use went up for a time, then decreased. People who had never had health insurance before needed time to learn how to use the system.
It probably is true that if we all make smarter decisions about health care less money will be spent overall. But consumer decisions probably are not among the chief drivers of cost, and “smarter” shouldn’t mean doing without medical care when you need it.