On why our current health care payments policies are stupid . . .

Are High Deductibles A Good Thing? Part I

. . . sadly you will have to wait for the follow up article explaining Goodman's Gold Standard Policy.

"Because I am often called the “Father of Health Savings Accounts” people sometimes assume that I favor high deductible health insurance. I don’t. In fact, I don’t really favor deductibles at all. Deductibles, along with co-insurance payments, are very crude devices that give patients very imperfect incentives.

What I favor instead is self-insurance for many kinds of medical expenses, including almost all primary care and most diagnostic tests. Where third party insurance is involved I favor fixed payments — wherever practical – with the patient self-insuring for any additional expense. (See, for example, Anthem’s experiment with knee and hip replacements in California.)"

Goodman nails the problems with todays health care payments policies. I began noticing this problem last year when Regence ash canned our policy and threw us on to the exchange. Exchange policies are packed with costly prepaid medical garbage that the upper middle class want but which are unnecessary, and likely to lead to poor medical outcomes. If you want to get a PSA, it will likely be paid for even though getting a PSA is a terrible idea. Since it is a policy "freebee" you are paying for it. Also here in Oregon all the policies came with multiple "free" annual exams, commonly 3. You are also paying for each of these exams in the premium. I realized those provisions accounted for much of the  2-3 times premium increase. After all, three people receiving 3 exams each year is pretty costly, and then one must add to that the fact that breast exams, prostate exams, colonoscopy, and mental health, among myriad others are all "free" in these policies.

The reason for my policy jumping from under $300 per month to over $800 per month with higher deductible, and poorer coverage was obvious. The costs of these "freebees" drove the cost up dramatically. Plus, the exchanges are populated with a sicker cohort of insureds, so, I was likely paying for a significant amount of their premiums as well. 

Luckily, my wife's business was bought by a larger corporation, and they offered a reasonably priced family health care plan, so we dodged a bullet.