In The Health Care Blog Matthew Holt discusses Jamie Robinson's article in Health Affairs on Managed Consumerism. He also mentions an article by Bob Berneson in the same issue of Health Affairs that points out many of the foibles of consumer directed health care.
...as Paul Krugman wrote yesterday in the NY Times in his “Healthcare Economics 101” column, the real issue is that the market for health insurance cannot be solved in an efficient or frankly humane way if we don’t have a universal pool. In other words it needs to be “rigged” so that insurers are no longer better off insuring healthy people. That at least was the concept behind managed competition, and it’s the same concept behind single payer, et al. It was not the concept behind market-driven managed care and is the complete anathema to consumer directed health care as exists now (and will in the future given that United has bought Golden Rule). And that is the elephant in the room that Robinson fails to note, for all the innovation in his schema.
Without real insurance reform, whatever we do we are never going to solve the core problems of cost (or even cost-effectiveness) and uninsurance. Anything else is lipstick on the pig.
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