The push for high-deductible plans is part of conservative policymakers’ fondness for “consumer-driven” healthcare, says Renee Hsia, director of health-policy studies at the University of California in San Francisco, “where we see patients as empowered shoppers who can and should be making decisions about their health care with their wallet.”
But according to Hsia, the problem is that health care doesn’t work like most other consumer goods. “For example, if I want to go buy a loaf of bread, I can easily see the ingredients, I can look at the nutritional information, I can look at the price, and I know the consequences of buying the loaf of bread and not buying the loaf of bread (i.e., it either means having it or not),” she explained. “If I have chest pain, there is no much information I don’t have: I don’t know what the diagnosis is, I don’t know what it will require if I do see a doctor to get to a diagnosis and what tests I will require, I don’t know the consequences of not getting treated are, I don’t know what procedures I will require even once I do get to a diagnosis.”
Multiple studies have shown that the amount different hospitals charge for the same tests can vary by thousands of dollars. That’s the kind of thing a consumer could “shop around” for, in theory—but not if there’s only one hospital in town. And past studies have shown that hospitals are more forthcoming with the price of their parking lots than they are about the prices for routine tests.
What’s more, several of the Trump supporters I’ve interviewed, including Tanya, say they want to be able to keep seeing their favorite doctors. That might not be an option if they’re forced to seek out the one that’s cheapest.
High-deductible health plans do cause people to spend less money on medical care—by about 5 to 7 percent. They especially avoid things like getting lab tests and filling their prescriptions, particularly in the first year they have the plan.
That’s because it takes a while for money to build up in the health-savings account, and also, there’s a “newness factor,” said Anthony Lo Sasso, a health-policy professor at the University of Illinois. “There’s a learning curve, and that probably tamped down spending.
They also become more careful about going to the doctor. “You might give that upper-respiratory infection a few more days,” Lo Sasso said.
But the intended effect—that people will learn to shop around for the cheapest doctor—doesn’t always kick in. A 2015 study of a firm that switched to a high-deductible health plan found that the employees didn’t learn to price-shop after two years. Instead, they just reduced the amount of medical services they received, including potentially valuable services like preventive care. People with chronic conditions delayed care for themselves and their children. This is a recurring issue with high-deductible health plans, according to Paul Fronstin, an economist at the Employee Benefit Research Institute who led a study of a large employer who adopted a high-deductible plan. People don’t know that certain services—like, say, flu shots—are excluded from the deductible. Or, they worry that while they’re at the (covered) appointment, the doctor will find a potentially-cancerous lump, which would then compel them to get a scan that’s not covered before their deductible. That suggests people on high-deductible plans are getting less care, not just cheaper care.