You wouldn’t want to waste your time reading a mediocre columnist – which is why Cohen the Columnist is so much in demand.
For many endeavors, mediocrity is a fact of life, even if we are not inclined to say so, out loud. When real estate agents mumble to clients about “price points,” the unspoken question often is, “Are we looking for a palace, like the home of a newspaper publisher, or are we looking for columnist digs, which is to say, at best, a fixer-upper?”
No area of public policy has been more distorted by our failure to concede the reality of mediocrity than healthcare. From houses to cars to restaurants to wardrobe, we feel free to openly prioritize our wants and needs – and opt for a certain level of mediocrity.
But we don’t feel comfortable being the champions of mediocre healthcare. We are squeamish about the notion that some of us (or, more likely, most of us) will be sentenced to mediocre healthcare, because the nation is not inclined to spend every last dime of GDP on health.
That’s not necessarily a terrible thing. Just as a mediocre car can still get us from here to there, mediocre healthcare can often cure our rash, or resolve our earache, or, if God is on our side, see our cancer cured by an oncologist who finished last in his class at medical school.
Just as community health centers can fill an important void for those not inclined or unable to toddle on down to be coddled by their private physicians (a point made previously in this column), almost every aspect of healthcare delivery is in a crazed search for – what else can you call it – a mediocre alternative to expensive care.
A recent RAND Corp. study revealed that the number of Massachusetts residents who have chosen – or been dragged into, kicking and screaming – high-deductible health insurance plans has doubled in a year. The high-deductible plans, on the face of it, are a mediocre alternative to the “Cadillac” plans of the good-ol’-days of corporate fringe benefits. The Massachusetts mandate sort-of-demands everyone has health insurance. A certain level of mediocre is just fine.
From a macro, high-on-the-mountaintop point of view, there are economists who suggest these “catastrophic coverage” plans are actually preferable, in that – again, at least in theory – they encourage consumers to shop around, rather than dutifully march in the door of the high-priced medical delivery shop on the corner.
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Decades ago, the old Golden Rule insurance company, led at the time by a cranky, politically conservative, entrepreneurial CEO, successfully championed the notion of this kind of medical insurance, unadorned at the time by tax incentives now available for high-deductible HSAs. More liberal types objected to the notion that the young and healthy would drift more readily to such insurance, rather than engaging in a big group hug where the healthy would somewhat subsidize the sickly.
And, to be sure, there were those who gravitated toward the low premiums of the high-deductible plans, without paying sufficient attention to how much money they would run through, before “insurance” kicked in. That’s what, in a sense, made it mediocre.
A Harvard study published several years ago in the Journal of the American Medical Association found that patients in traditional health insurance plans who switched to high-deductible plans visited emergency rooms less often – especially for repeat visits to follow up on less severe conditions. Were they wise consumers? Were they health morons risking their lives? Such clinical analysis remains a bit murky.
With Massachusetts the pioneer of mandated coverage, the drift toward high-deductible plans is a trend worth watching for the rest of the nation. If consumer insurance plans are truly going to encourage consumer vigilance, the “prices” charged by doctors and labs and hospitals are going to have to undergo a serious disclosure improvement.
“How much for that appendectomy, doc? Sorry, I’m going to the faith healer down the corner; he’s having a sale.” To put patients in charge of their healthcare decisions is an important, American-flavored instinct, but Mass General doesn’t advertise loss leaders: THIS WEEK ONLY! RADIATION THERAPY – 75 PERCENT OFF.
