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In Health Care, Is Complexity More Problematic Than Cost?

by Nancy Metcalf

Wednesday, January 29th, 2014

This commentary offers reflection on the findings and implications from "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?" Nancy Metcalf is a senior editor at Consumer Reports magazine who reports on health. She has answered thousands of consumers’ questions about health care and insurance in her “Ask Nancy” column.

Here is what consumers in other advanced industrial democracies need to understand about their health care systems: practically nothing. From cradle to grave, their health care needs are met nearly automatically by mechanisms that operate behind the scenes. No one has to worry about picking the “wrong” health insurance plan, or not being able to afford the cost of a serious illness or injury. There are no serious public debates about whether doctors make too much money, whether governments are in the pocket of the drug companies, or whether some people are “free riders.” It just never comes up, because these countries long ago reached a political consensus that health care is a human right, and that “social solidarity,” a term that most Americans have never heard, dictates that it be available on an equal basis to all.

The citizen groups convened by Public Agenda illuminate how Americans interpret their experience with an impossibly complex system that offers far less and demands far more of them as consumers than any other country’s.

  • They (erroneously) blame high costs on insurance and pharmaceutical companies, whose prices they regularly see up close and personal whenever they write a premium check or pick up a prescription at the drugstore. But they accept the (equally erroneous) idea that high-powered specialists and prestigious hospitals, who are the true drivers of high costs in the United States, deserve their big bucks.
  • Having experienced for themselves the disorganized care that our current system delivers, they like the idea of measures to coordinate care. This is perhaps the most encouraging finding from the entire exercise, because the delivery system reforms built into the Affordable Care Act and the Health Information Technology incentives from the 2009 stimulus bill are already having a noticeable impact on care coordination. I recently wrote an article on Patient-Centered Medical Homes and saw for myself how enthusiastically patients receive them.
  • Somewhat surprisingly, given how Americans have been taught to value “cutting-edge” health care, consumers are beginning to recognize how providers can drive overuse of services in general and expensive technology in particular. But they don’t seem to have much of an idea how to address this problem.

I was asked to comment on how providers and insurers can use these findings to improve communication with consumers. That’s a worthy goal that I find myself in slight disagreement with. Clear language and transparent prices are fine and necessary, but the ultimate goal should be a health care system that shields consumers from its underlying complexity as much as possible.

Absent the creation of a single-payer system, we are stuck with the patchwork mess we have now, which health reform will vastly improve in terms of access and affordability but simplify little if at all. So for the time being the focus should be on benefit designs that automatically push consumers towards higher quality, more cost-effective care. Tiered networks and reference pricing are promising starts. The price competition that we can already see developing on state insurance exchanges will, I hope, drive more innovation in this area.


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