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November
2004
Home Depot Health
Care
As the price for getting
conservative lawmakers to “socialize” Medicare
to cover the cost of prescription drugs for seniors, the Bush administration
agreed last year to the creation of medical IRAs. Known as Health
Savings Accounts, they allow individual workers to set aside their
own money to spend as they choose on health care or to roll over
the money, with interest, until they need it. The catch is that
workers have to enroll in an insurance plan with a high deductible,
covering them for only the most serious illnesses.
Leaving aside the financial and political ramifications of setting
up an insurance plan that will benefit largely the young and the
healthy, the question I think is important is how people will know
how to spend this tax-free money wisely. Some ideologues sniff
that the people are always the best judge of what to do with their
own money, but that presupposes a system where price, quality and
value of a product are transparent.
Health Savings Accounts
only exacerbate a problem of growing concern under any payment
system — how to make the right selection
from a cornucopia of confusing choices. In a more perfect world,
everyone would have access to the same information, have the same
health literacy skills and have a range of competitively priced
products and services to choose from.
Buying health care can
be like wandering lost in a Home Depot looking for a common nail
amid an acre of chain saws, garage door
openers and lawn furniture. If you happen to find a salesperson
who actually knows anything, you may get what you want. Otherwise,
you are the mercy of “nail and staple,” “paint” or “window
treatment” subspecialists whose livelihood depends on selling
you something you may not need.
In health care, even the best-informed consumers can be at a loss
when the current state of medical science offers conflicting treatment
choices.
As Americans become
older and health costs rise, there are going to be many more
choices of doctors, drugs, tests and hospitals
that we have to make on our own. The main trouble with schemes
to give you “ownership” of your health care dollars
is that they value choice at the expense of the right answer — an
individual answer that is often tough even for a doctor to decipher,
complicated by family and medical history, co-occurring diseases
and personal characteristics like allergies.
So far, the private sector has yet to offer or sell many of these
new Health Savings Accounts. But regardless of whether they ever
do, the hope that people will use good scientific evidence to make
decisions about their health will never be realized without a serious
effort to ensure that solid, comprehensible and comprehensive information
about health is available to all.
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