This I told you so thing is getting too easy. Here is another example.
It appears that many consumers are starting to realize the relationship between what you spend on health care and the premiums you pay. That would appear obvious, but with the Administration focusing on premiums and premium subsidies and all that affordable health insurance nonsense, the truth was blurred … perhaps intentionally.
This problem is not unique to Obamacare exchanges. Employers moving to high-deductible health plans are causing the same issue and perhaps to a greater degree.
In any case, many Americans are now realizing that having health insurance does not always mean that health care is “affordable.”
Additionally, the report found that, out of adults with deductibles of $1,500 or more per person, nearly 30 percent went without needed care because they couldn’t afford it. For those with deductibles under $1,500 a person, only 19.6 percent went without care.
When it comes to selecting health plans, most individuals chose bronze and silver plans because of the lower premiums–the average deductible of silver plans in 2014 ranged between $2,267 and $3,030, noted the report.
Insurers can do more to make their plans more affordable for consumers.Connecticut’s health insurance exchange, for instance, requires all insurers to offer a silver plan that exempts basic outpatient services–such as prescriptions for generic drugs–from the $3,000 deductible, reported the Washington Post. In turn, the consumer pays a co-pay of $10 for the drug prescription. [which of course is going backwards and raising premiums]
Even though high deductibles are part of a growing cost-sharing trend in health insurance–which has helped reduce the increased rate in health spending–the recent debate at hand is whether high deductibles actually help or harm people’s health, FierceHealthPayer previously reported.
via High deductibles main reason Americans go without medical care – FierceHealthPayer.
QUINNSCOMMENTARY 
So, you may want to look at this issue again. As noted in other, prior posts, people don’t shop once they change from being consumers to being patients. Similarly, this article also confirms that sick or healthy, people tend to delay treatment where the “return on investment” is not immediate, whether the return is positive or negative.
http://www.vox.com/2015/10/14/9528441/high-deductible-insurance-kolstad
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First, I doubt people go without needed care. It is certainly true, based on long ago studies by Rand and more recent confirmations, that as people have to shell out money from their pocket, they are much more careful about spending on health care. But for the same behavior would apply when it comes to homes, vacations, cars, entertainment, etc. – that people would “save up” and minimize debt and prepare for contingencies. Also, a 10% difference in a survey responses may, or may not be statistically significant – given the variation in people’s responses to surveys and the likely different interpretations of such a question.
More importantly, as I have noted before, it is certainly correct that any deductible will be too much where there is no financial preparation. Surveys show most Americans live paycheck to paycheck. My favorite is the American Payroll Association survey each year that shows between 65% – 70% of Americans would find it “somewhat difficult” or “very difficult” to go one week with a delay in their regular paycheck. Not miss a check, but simply delay one week! Is there any surprise, then, that people will think twice when they have to shell out for “unexpected” (that’s a joke) medical expenses.
So, the solution here is for people to accumulate assets for the time when expenses do come – medical or otherwise.
Remember that the alternative, 1st dollar health coverage, is probably not a workable solution for most Americans, either. It requries much greater up front financial support that does not build any cushion for the time when expense is incurred – meaning it must be maintained indefinitely – cradle to grave, womb to tomb. Remember also, that today’s $1,500 deductible is the inflation-adjusted $100 deductible from 30 years ago.
So, the concept of enrolling in a HSA/CDHP combination, and actually putting money aside for the day when expense does come, is more akin to funding a lifetime of day-to-day medical expense (short of catastrophic expense) over a lifetime, while funding catastrophic expense with insurance. So, High Deductible Health Plans and Health Savings Accounts only work where they are actually used, where people fund the accounts in anticipation of day-to-day and periodic medical expenses. And, where deployed properly, HSA/CDHP programs have been shown to be successful for almost all workers.
The exception, where an effective HDHP/HSA combination will not be sufficient coverage, would be for those with significant chronic medical conditions and those with truly catastrophic medical expenses – hundreds of thousands of dollars and millions of dollars. There, accumulating sufficient assets in the HSA to cover out of pocket expenses is probably not within reach of most Americans. However, that is not what the article nor your column is focused on.
So, sooner or later, people will search for a solution to PPACA’s shortcomings, and the cycle will repeat. Maybe that will occur in time to retain the employer-sponsored system most Americans have, and maybe, as predicted by Professor Emanuel and Professor Gruber, it won’t.
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I can’t agree in total with your position that HDHPs work well except in catastrophic situations. I think average expenses put people at risk as well especially average income people. My three year old granddaughter was in the hospital one night recently admitted through the ER. Those couple of days wiped out the $2500 my daughter was able to put away for the year and obviously she has to start over next year to accumulate funds. As you well know, you don’t need a catastrophic medical event to use up a $2500 deductible pretty quickly.
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Hopefully, they don’t have that expense every year.
But, if they had a $500 deductible instead of $2,500, my bet is that their annual contribution would be $1,500 more a year. So the difference is maybe $500 to $1,000 or so, and once you adjust for tax preferences , less, perhaps much less.
Lowe deductible = higher contributions, every year, whether there is an er visit or not.
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