Health Care: What if we Play the Games Differently?

Twenty-plus years ago I worked for an attorney who said that whatever didn’t require his law degree to do, could-and should-be done by someone else. He trained his staff as paralegals. I started my professional career learning to think strategically and ask different kinds of questions–about a lot of things. Today that includes health care, health insurance, and the increasing costs to both employers and consumers.
I’m a business and human resource professional, a consumer, educator, and wellness coach. I’m not a medical or health insurance expert. I do know that people behave and act based on motivators and rewards. In general, wherever the incentives are placed, and or monitoring is done, action will take place and the monitored results will be achieved. Parents know this; teachers know this. It’s a basic principle of education.
The answers will not magically come out of one essay. The subject is complex and as individualized as consumers. It’s unrealistic to think one solution will fit all contingencies. My objective here is simply to tap the interests, experience, and expertise of the players, and get all of us thinking outside the “rules” a bit. Like pieces of a giant jigsaw puzzle, we all have important pieces of information and experience to contribute.
In childhood, didn’t we learn the value of playing outside the rules once in awhile to achieve the objectives we wanted? I did. Our family version of Monopoly included IOU sheets. Mom invented them so she and all of my siblings could stay in the game and play as long as we wanted to (allowing her to could keep us occupied and together)-her desired objective at the time.
Asking questions is key. Different questions get you different answers. Knowledge is interesting and empowering. Here are some questions I’d start with:
Health Care
What requires a doctor’s medical degree? What doesn’t? What medical, health, or wellness practitioner has the expertise needed and is the most practical (and cost-effective?) resource to address your condition?
What is the best utilization of RNs, for example, and other health and wellness practitioners? Now? In the future?
What is our definition of Health Care? Is it too broad? Or too limited? What benefits can alternative, integrative, and or experimental approaches offer to the consumer? To the employer? Consider costs, including lost time away from work, effectiveness, and incentives for use-or non-use.
Health Insurance
What are the cost / pricing factors? How does health insurance compare with auto insurance, for example? Is your rate affected by your claims, or lack thereof? In other words, is there a monetary incentive for consumers to stay healthy and make healthy life-style choices? What are the cost drivers? What’s covered by health insurance plans? What is excluded? Should health insurance be employer provided? Or is it time for portable consumer-owned programs/policies? Are there other options? Now? In the future? What exactly do we want health insurance to insure us against? Normal maintenance expenses? Or major events and expenses?
Laws – Tax incentives
Who benefits? Are there tax incentives to reduce consumer medical expenses? To invest in wellness and health? Or are there dis-incentives?
Section 125 – Flexible Spending Accounts, Medical Savings Accounts, Health Reimbursement Accounts. What are the allowable expenses? What expenses are excluded?
The Playing Field has Changed.
The health insurance-health care game and the playing field have changed. Why?
Because employers, small business owners, and solo entrepreneurs cannot afford to pay as much of the health insurance tab as they once did.
Because we are a much more mobile, connected, and better-educated workforce today.
And because the old rules don’t fit today’s business and lifestyle environments the way they did when the current systems were designed.
At present, health insurance is most commonly connected to ones employer. When you change jobs, your health insurance does not go with you. Yes, there are COBRA laws for continuation of your health insurance for a limited time at the full premium rate. That leaves one looking for another employer to provide health insurance benefits, get independent coverage elsewhere, or go without. In today’s economy, many more are choosing the “going without” option. More people are unemployed. Some work one or more part-time or contract jobs-generally making them ineligible for employer-provided benefits.
The workforce and the “company loyalty” standard have changed as well. Baby Boomers and the generations after have been downsized, right-sized, and “early retiremented” out of jobs and companies on a regular basis. The younger generations paid attention. Many professionals intentionally change jobs and companies more frequently to build their career experience and increase their salary. Relocation is often part of the recruitment package. Yes, insurance benefits are still an important deciding factor in selecting employment–not always the most important one for this group as it is (was?) for the Boomer generation. Salary, flexible work schedules, flexible benefits, and paid time off are prime desired-benefit competitors. The trend toward flexible staffing options, utilizing temporary and contracted workers instead of full-time direct employees, continues to grow to accommodate the fluctuating business marketplace. Both technical and blue-collar workers are frequently “placed” by staffing agencies. Temp-to-perm recruiting arrangements for some positions are common, and often the preferred option. Most temporary staffing agencies do not offer health insurance.
All of these factors, in addition to the surge of small business entrepreneurial endeavors, have led to a ready market for affordable health insurance through independent providers. Health insurance companies are now directly targeting consumers in their advertising. Online providers like www.eHealthInsurance.com and www.insure.com make it easy for consumers to do comparison-shopping and purchase health insurance directly through their site and offer live customer service reps to assist. Consumers now have more options and choices than anytime before this.
What if Health Insurance was more like Car Insurance?
So what if your health insurance was more like your auto insurance, for example? You own the policy, and you work with an insurance agent or an online brokerage? And what if the provider networks were national–or international. When you switch jobs, you keep the same policy–even if you move across state lines. What if employers get out of the health insurance business and provide other related benefits instead? For example, what if employers could provide tax-free flat amount contributions to individual medical savings accounts of their employees? What if employers would provide an annual wellness allowance, and incentives for employees to actively engage in healthy lifestyle choices? What if there were significant monetary incentives from your insurance company for personal wellness habits and claim-free years, such as significant rebates on your premiums, for example?
What outcomes do you want? Where do you need to put the action incentives?
If we want to reduce consumer health care and hospital costs, maybe health maintenance and wellness activities need to be significantly monetarily rewarded somehow. We all know smoking and other addictions translate into expensive medical costs; that super-sizing our meals without increasing exercise levels adds to our waistlines and expensive medical costs; that irresponsible sexual choices and practices have expensive consequences; and that our stressed-out lifestyles have costly consequences. These are all areas of individual responsibility and opportunities for healthier lifestyle–and cost reducing–actions.
There are still the majority of consumers who would rather have “somebody else” take care of all the health insurance stuff for them. And who can blame them? The mountains of insurance forms, billing statements, coded charges, and terminology can be daunting to common consumers. Then again, here are some more questions:
Who or what is driving all the paperwork?
Is it REQUIRED to be coded and confusing? Or is simplicity an option?
One significant challenge to consumer education and consumer-drive health care is that consumers don’t see a NEED to learn more. The incentives, motivators, aren’t in the right place–yet. Many workers are still in the “somebody else takes care of this for me” and “I really don’t have much choice anyway” mindset. For some, that may be true. Then again, little actions–doing something differently, like spending our money in different places–can have a ripple of effect of consequences. By knowing the cost drivers and our options, one can make informed choices and start the ripple effects in the direction we want them to go. If we do nothing, inaction also has consequences: the old game stays the way it is.
And there are some players with a vested interest in keeping it that way.
Getting Past the Fear Factors
First, let’s get past the fear factors. Just because insurance and health care issues are complex and can be confusing, doesn’t mean we can’t learn to be smart shoppers. We have learned to become smart shoppers and savvy consumers in a lot of other important areas of our lives: buying a car or a home, finding a mate, running a household, raising children, or starting a business, to mention a few. Just as we tapped the experience and expertise of others in those areas, we can in this one too.
Who has the knowledge and information you need? Which of these are education- and consumer-focused?
The Internet is a phenomenal resource for consumer information, education, and participation. So are many knowledgeable health and wellness practitioners, and common everyday people, in our neighborhoods. Watch for consumer education classes and health and wellness events on topics of interest. Ask questions. You are the customer. You know you want to learn more, and you want it in plain terms you can understand, including pricing and background information on services and providers. Like your homework process in any other buying decision, make your list of what you want to know and prioritize what’s important to you. Then use your brain and your voice, and keep your ears and eyes open to information sources. You’ve made good and informed decisions and choices before. You will here too.
Start where you are, your health and your family’s health. Start becoming an educated consumer. Pay attention to the cost drivers. Ask for cost information from providers–in understandable terms. Seek out information you’re interested in. Be open to learning.
Existing systems are not likely to change overnight. You can use new knowledge to start making healthier, and more strategic, choices though. And you can start playing the game differently as a result.
Maybe all of us together will find and create new solutions and consider approaches we never took seriously before. I invite you to add your knowledge and creativity and questions to mine. We’re in this together. The objective–at least for me–is aligning consumer and employer behavior incentives with cost reduction, happier and healthier people, and better utilization of practitioners. So start asking different questions….and be open to new possibilities. It’s your life, your body, your money, and your business.
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About the Author:
© Anne Wondra (2004) Anne Wondra is a business and human resource professional, workshop leader, wellness coach, and creative muse. For more life enjoyment, visit wonderspirit.com.