• What are the other comparison groups? In Safeway’s case, Burd calls them “most American companies.” But just which ones—other national food chains, car makers, drug companies, or toothpaste sellers?
• Are there data that show employees are actually using fewer medical services?
• Are there data that show employees have actually changed their bad behaviors if indeed the cost reduction is due to such a change?
And, while the diggers are at it, they should remember that companies touting their anecdotal evidence may have other agendas. Burd says that “we are constrained by current laws from increasing these incentives.” By that, he means the payments a company can give employees who, say, have stopped smoking are too small. “Reform legislation needs to raise the federal legal limits so that incentives can better match the true incremental benefit of not engaging in these unhealthy behaviors,” says Burd. Some emerging bills do contain such incentives. Are these good investments for taxpayers? Such op-eds, which are really another form of lobbying, don’t often answer that question.
As Russell and Oberlander point out: Studies tell us that when people have to pay more of the costs for their care themselves, they tend to use less of it—and of course, spend less.
I see this statement all the time as it relates to the healthcare issue and I wonder if the abuse is really as systemic as is implied? If so, is it abuse by the patients or the doctors or both?
And while a Safeway-style coverage instituted nation-wide would certainly address frivolousness, would it not also result in patients generally self-rationing in an effort to keep down short-term costs, but then incurring long-term and/or more expensive costs to address health issues that could have been stopped early but were let slide due to the earlier decision to not spend?
Truly curious about this, not trying to be provocative...
#1 Posted by TotallyDaft, CJR on Wed 1 Jul 2009 at 06:17 AM
We weren't saying that having people pay more was a good idea, only that paying more, not Safeway's incentives for healthy behavior, are probably the reason why its costs stayed flat. Incentives for healthy behavior haven't been part of the Safeway plan long enough to be responsible for keeping costs flat for the last several years.
The basic idea behind health insurance is that people should not be limited by their ability to pay when they are ill. Every high-income country, including the US, accepts that principle. But since ability to pay does not then limit how much is spent on medical care, every country also has to decide whether and how to do so in some other way. Only the US has chosen, as part of its cost-limitation strategy, to leave 50 million people uninsured.
#2 Posted by Louise Russell, CJR on Fri 4 Sep 2009 at 11:50 AM