The Ownership Society

That's the society where they own you.

We've already squandered a substantial share of the universe's finite supply of bits beating the long-dead horse of Consumer Directed Healthcare™ here and at Critical Condition, but since the Bullshitter in Chief plans to ride this zombie steed into the chamber of the House for his State of the Union speech, we might as well keep working it over.

The concept that everybody should have really crappy health insurance, with high deductibles and co-pays, and then get various tax breaks -- straight deductions for expenses, and tax advantaged health savings accounts -- to subsidize their high out-of-pocket expenses -- would seem to have three consituencies who would find it rationally in their interest: financial services firms that would get to administer the health savings accounts, and skim off management fees; rich people for whom the tax breaks are worth a lot and who will benefit from the upward redistribution of income that the whole scheme implies (kind of a long story); and employers -- particularly in low-wage, labor intensive industries, such as retail and restaurant chains -- who will be relieved of pressure to provide decent health care insurance to their employees. (And by the way, they aren't waiting. Friendly's restaurant chain has just announced that it's moving hundreds of its full-time employees into high deductible, high co-pay insurance plans.)

Opposed would be physicians and hospitals, insurance companies (whose business will become less lucrative), and oh yeah -- everybody who eats and breathes. We've already explained why this scheme is not going to hold down health care costs, is not going to "empower consumers," is going to cause millions of people to be impoverished by misfortune, and is going to make health care less rational and effective by reducing use of preventive and early intervention services and causing people to end up sicker and needing more expensive treatments.

But now, just for the heck of it, the Commonwealth Fund has sponsored a survey of consumers to see how they like the high-copay, high deductible plans, compared with real health insurance. (Warning: presentation uses bizarre slide show technology, and the PDF crashes my Acrobat every time.) Big surprise! They don't like them nearly as much. This was an Internet survey, so it can't be presumed to be representative of the population, even though they weighted it by obvious variables such as income.

Still, for what it's worth, people who had the so-called consumer-driven plans (high deductibles and health savings accounts) were far less likely to be satisfied with their plans, spent more on out-of-pocket expenses, and "were significantly more likely to avoid, skip, or delay health care because of costs than were those with more comprehensive health insurance, with problems particularly pronounced among those with health problems or incomes under $50,000. About one-third of individuals in CHDPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, compared with 17 percent of those in comprehensive health plans."

The only way to sell this to the public is to bamboozle them. The gang in charge used to be pretty good at that, but I'm betting this one will go the way of Social Security privatization. Anyhow, it had better.