Consumers face what many health care experts describe as two distinct tracks of care for those lucky enough to have insurance through their employer.
Track one: the common, and increasingly expensive, alphabet soup of plans such as HMOs (health maintenance organizations) and PPOs (preferred provider organizations) in which millions of Americans participate today.
Track two: relatively new "consumer-driven" packages, backed by President Bush, that encourage people to enroll in high-deductible plans and then set up tax-sheltered accounts to help pay for what's not covered. The theory is that individuals will be thrifty in their medical choices because they can keep whatever funds they do not spend.
"Employers are looking for relief, and they don't know how to achieve that relief," said Ron Pollack, executive director of Families USA, a consumer group that supports health care for all. "So the one tried and true thing they feel they can do is shift the costs from their part of the ledger to the worker."
Those workers spent ever larger shares of their paychecks on health care and got less for their money in recent years, federal and independent studies suggest. The number of Americans spending more than a quarter of their income on medical costs climbed from 11.6 million in 2000 to 14.3 million last year, Families USA said. And premiums increased faster than overall inflation during the past six years, the Kaiser Family Foundation reported.
Consider Maureen Hong of Denver. When her husband, Philip, retired from his engineering job three years ago, the couple began paying $191 a month in premiums for an employer-sponsored PPO.
Last year, they paid $318 a month in premiums for a less-than-ideal HMO after the company yanked the PPO plan from its array of choices. The couple could have opted for a new high-deductible plan similar to those the Bush administration backs. But they decided against it because Maureen Hong suffers from a chronic condition. They knew they would easily pay $10,000 out of pocket to meet last year's family deductible, she said.
"I'm angry that this is what the system has come to," said Maureen Hong, 60, a self-employed medical billing advocate. "Actually, I guess 'disappointed' is a better word. At least, I'm grateful I have health insurance."
Don't blame the companies for the nation's health care woes, said Helen Darling, president of the National Business Group on Health. Just like consumers, employers are getting clobbered by costs for reasons beyond their control.
Most companies have been wrestling with price deflation for years, forcing them to deliver more goods for the same, or even lower, prices. They're also coping with an "uneven" health care system fraught with medical errors, she said.
