MANAGED CARE March 2006. ©MediMedia USA
Whether you take the story of the fall literally or consider it an interesting contribution to humankind's reservoir of mythology, the lesson of the narrative cannot be easily dismissed. It is about how free will entered the world riding on a serpent's tail. Remember that once the decision was made, the apple eaten, and Paradise left behind, the blame game got under way. And you are wondering what this has to do with health care coverage, aren't you?
Contributing Editor MargaretAnn Cross's cover story examines discretionary spending in health care [1]. She finds that nobody really knows for sure just what procedures patients will decide to do without once faced with the reality that the cost comes out of their health savings accounts. "Discretionary" is a vague concept right now.
Given that serious illness will eat at the 80/20 coverage that kicks in after it swallows an HSA whole, you wonder why there isn't more concern about this. At the very least, clear definitions need to be in place, especially since the spending a patient may avoid, at his or her discretion, involves preventive care. ("Guess I'll skip a mammogram this year and buy some cool eyeglass frames.") The bill for that choice eventually comes due.
MargaretAnn's article discusses some plan designs that draw a line between discretionary and necessary by reducing or eliminating copayments for drugs, for example, whose use is in everyone's interest. But how is a person to be sure that he has indigestion and not a heart attack?
Like Adam and Eve, some will always gamble that they won't get caught. I am reminded of those enticements that Atlantic City casinos used to offer old folks: Free transport and $10 to gamble. The smart ones would pocket the cash and stroll the boardwalk.