The current trend in health care reform, and a key component of the Massachusetts Plan, is consumer-drive health care. Consumer-driven health care aims at the other moral hazard problem in heath care: Patients’ tendency to seek out and use more medical care when they are insured than they would otherwise. Under prepaid managed care and third-party payment, patients are shielded from true costs and have no direct incentive to reduce their health care utilization. Health savings accounts (HSAs) and high-deductible health plans (HDHPs) are supposed to force patients to appreciate the true costs and make conscious, price-driven decisions about whether to seek and forego medical care. As a part of that decisionmaking calculus, patients, not physicians or plan administrators, are expected to judge for themselves what care is medically necessary versus merely “discretionary.” Michele Melden has a thoughtful, comprehensive piece on HDHPs in the Loyola Consumer Law Review.
If managed care operates from the premise that physicians can't be trusted to decide what is medically necessary without administrative oversight, it's hard to see why patients themselves should be expected to determine what care is medically necessary versus merely discretionary. Especially when patients typically possess far less price, quality, and availability information about health care services and products that they consume than retail shoppers browsing the Sunday advertising circulars for specials on high-definition televisions (HDTVs). Are we really better off as a society if a seriously ill patient declines to spend $3000 out of a HSA or HDHP premium for follow-up care and opts instead for a $3000 HDTV?