Consumer Directed Healthcare -- A Rant to the Ridiculous

Last evening I attended a program put on by our local medical society that provided local doctors and others the opportunity to look at healthcare payer systems from a variety of standpoints. Four gentlemen, each with a different perspective, shared their knowledge about the systems they support:

• The CEO of our local blue cross, blue shield -- a private insurer
• A doctor who supports and speaks on behalf of the AMA
• A long time doctor who is unabashedly in favor of a single payer system
• A college professor who is even a bit to the left of single payer

One of the recurring themes was one I embrace -- a tip to the hat of the patient -- the idea that patients should be taking more responsibility for their corners of the healthcare delivery equation.

To date, I have remained as neutral as I can in these conversations. I see my role as one who can help us understand the questions, and one who can help us all understand how each form of reformed system might impact, or be impacted by, the answers to the questions. So far so good.

But there is one term being bandied about that truly riles me every time, and I heard it a number of times last evening. Private insurers keep talking about moving patients toward CDHPs or Consumer Directed Health Plans. CDHPs are really a euphemism -- a very positive sounding term used to cover up what they really are -- catastrophic health policies. They are called catastrophic because they are the policy of last resort, usually the only way for someone who does not get employer-provided health insurance, and is not eligible for assistance programs or Medicare, to afford health insurance. Catastrophic because the amount you pay in is less than if you could afford more coverage, but the amount of the total cost the health insurance company picks up if you do get sick (in a catastrophe) is negligible.

I had one of those CDHPs. When I was going through my misdiagnosis, I was self-employed and unmarried. The only insurance I could afford was "catastrophic" -- meaning -- I had a $5000 deductible and 60/40 after that -- after I paid the first $5000, I would pay 40% and the insurer would pay 60% for anything over and above the first $5000. And I'm sure there was a cap on what they would pay in total, although I don't remember what it was.

What does that really mean? What it really means is that I paid out almost $3,600 in premiums for the "privilege" of paying out $5000, plus another $2000 in costs. At the end of my misdiagnosis, the health insurer's total out of pocket was $1,400 and mine was $10,600. And that doesn't include the tens of thousands of dollars I'd paid into the system for years before I had a medical problem. And don't forget, the expense was incurred for a misdiagnosis -- something I didn't really even have.

Now what exactly is so consumer-directed about that?

Now don't get me wrong. I know it would have cost me more -- $1400 more to be exact -- if I had not had insurance. But did I "save" that much? Perhaps not, because many doctors will negotiate their fees for cash payers. (And because I went back to the doctors who were wrong and insisted I would not pay them -- and didn't.)

But I suggest to the private insurers that they begin to call "consumer driven healthcare plan" exactly what it is. A "clean out the consumer's bank account while we pretend we are providing a service in their best interests" plan.

There's GOT to be a better way. I might have done better playing the lotto.
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