Enthoven on Americans’ sense of equity
The 11th Princeton Conference:
Managing Cost and Quality Through the Health Care Delivery System:
Managing Care within Organized Delivery Systems
May 21, 2004
Question from audience:
…do you see this push for the health savings accounts, the health reimbursement accounts as being something which is likely to promote or work against the development of prepaid group practices and the image that you see (employer making a fixed dollar contribution and granting employees choice of competing plans, especially prepaid group practices)?
Alain C. Enthoven, Ph.D., Marriner S. Eccles Professor of Public & Private Management, Stanford University:
Well, I think it works against because it tends to shred the fabric of solidarity. …I think the high deductible approach is a real mistake… In fact, Kaiser Permanente is surrendering to the inevitable in introducing $1500 deductible plans because they have to because their competitors are doing it in small groups, and they’ve been losing members in small groups. But I think that the $1500 deductible idea is going to shift costs from the well to the sick. Right away those people with chronic conditions are going to be paying $1500 a year out-of-pocket that they weren’t paying before. And, I don’t know, maybe that’s another route to the single payer. You know, when enough Americans are–when their sense of equity is offended by that, then maybe a lot of them will say, well, it’s time for us to have national health insurance…
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1159
Comment: Professor Enthoven’s vision of managed competition has never really been tested adequately since every player in the age of managed care jockeyed for their own best positions, rather than cooperating in developing an ideal market of truly integrated health plans competing on quality and price. And there is no conceivable scenario in which his model ever will be adequately tested, especially since even large healthcare markets cannot support enough fully integrated and mutually exclusive health systems to establish a competitive base.
We have now moved into the age of consumerism in which healthcare costs are
contained by making patients individually sensitive to those costs. Every rational health policy expert agrees that patient cost-sharing will shift costs from the well to the sick. Certainly Professor Enthoven agrees.
It seems that, as we investigate various models of reform and recognize the deficiencies of each, we keep turning our thoughts to the possibility of adopting the single payer model. Even Professor Enthoven recognizes that our sense of equity may bring us to that.