Why Health Reform Will Be a Danger to Passive Patients

Dr. Bernadine Healy

Video: Health Insurance Basics

[Find out how secret pricing of drugs and medical procedures makes your healthcare more expensive.]

Lately, there's been an acerbic war of numbers between the White House and insurance companies over how much reform will actually stress Americans' wallets, leaving the average observer with a case of whiplash. Just recently, several insurance groups released estimates of what might happen to the cost of private coverage. On average, premiums would go up, though not for everyone. WellPoint projects that a 25-year-old healthy man from Los Angeles (without parents to help him out) would see his monthly premium more than double, while a 60-year-old less healthy couple in the same town would see a 37 percent premium reduction.

[Read about how health reform taxes the young.]

The White House quickly dismissed the insurers' reports as bogus, pointing out that federal subsidies will temper the cost burden for individuals with incomes of about $45,000 or less and families of four who make about twice that. (Families whose yearly income creeps up past $90,000 will face full premium costs.)

In any case, you'll retain some control over your premiums. As is true now, a health maintenance organization would generally cost less than a plan that offers a wider range of hospital and doctor choices. On the new health insurance exchange, people would shop for the best price available for the same mandated benefits among a variety of private plans and possibly one set up by the government. They would also be able to lower their premiums by accepting higher copayments, should they get sick. (On the other hand, one could elect to pay more for such supplemental benefits as dental and vision care that aren't in the mandated package.)

Managing copayments wisely demands two things: that you have money set aside to pay them and that you start insisting upfront on information about the price of any treatments you face. Comparison shopping can save smart patients hundreds to thousands of dollars, since prices of even standard tests like an MRI or an exercise stress test can vary wildly for no apparent reason. But patients will need to nudge a medical culture that's not been comfortable laying out charges ahead of time.

Price-conscious folks, particularly the young and healthy, might want to think seriously now about choosing a low-cost, high-deductible "catastrophic" plan that allows them to funnel tax-free dollars into a medical savings account. These policies will be phased out under health reform, but the president has assured people they can keep a plan they like even if it doesn't meet new specs as long as they're in it before the new program is implemented.

When President Obama began selling reform, he cited the threat of healthcare costs to the entire economy as a prime driver. But savings will take time. In late October, the chief actuary at HHS reported that over 10 years, total national spending on healthcare will rise more under the proposed system than without it. That doesn't surprise University of Virginia policy expert Elizabeth Teisberg, coauthor of Redefining Health Care, who cautions about creating a whole new expensive system without first understanding whether it offers good value. It's perhaps a stretch, but some experts claim that half of all delivered care doesn't really help the patient. Teisberg says, "As we bring more people into the system, we have three choices: Spend more, ration more, or improve value." From the patient's point of view, the choice is obvious.

[Related: Why Rush Health Reform? Let's Fix Insurance First.]