The Insurance Puzzle

There was enough left out of "High Deductible, High Risk," [Oct. 18] to give a slanted view of consumer-directed health plans (CDHPs). Actually, it is more accurate to call them CIHPs, the "I" standing for "involved."

There are many different plans that fall under CDHP, and there are differences between group and individual plans. They were not at all distinguished in the article. And if someone had a $10,000 out-of-pocket total for the year, they were either not involved enough in the buying decision (i.e., they were asleep at the switch) or they were sold a bill of goods.

We have come to think of co-pays and next-to-nothing deductibles as a birthright. (Unrealistic co-pays and deductibles are what was driving into the ground General Motors, which spends more on health insurance than they do on steel!)

True, CDHPs may not be appropriate for people who have current ongoing health problems. However, in a properly devised plan, someone who gets into one when they are healthy will have the funds available to cover their out-of-pocket costs when health problems do occur.

The solution is not bashing these plans, which economic considerations dictate as likely to be the standard in the future, but in a consumer willing to understand alternatives and an agent committed to helping them understand.

Bernie Cohen

Falls Church

One aspect not mentioned was discounts consumers can get from docs by paying cash (credit card or check) immediately upon service. A local clinic up here (Dutchess County, N.Y.) charges $120 per office visit; $60 for cash on the barrelhead. Since the back-office paperwork for docs is a nightmare and their cash flow is screwed up awaiting claims' payment, these sort of discounts for cash are not due to the docs' generosity.

Calling standard pay-for-everything medical coverage "insurance" is a misnomer; it's just a shared-cost, pass-along system where the relatively healthy get nailed paying for the sicker in a group plan. I've got a $10,000 deductible and a health savings account that provides a small federal tax break. Despite the fact my premiums have tripled in the last three years or so, I still think this is a good deal compared to the outrageous premiums that are charged by HMOs, et al.

The larger question seems to be how the United States can spend a much higher percentage of its GDP on health care than other advanced economies with seemingly no better result. (My not uninformed hunch is the insurance companies are a major fly in the ointment; among other things, check out what the managements of these companies are paid.)

Eric Petersen

Stanfordville, N.Y.

One aspect you didn't cover is that many health care providers are not set up to tell consumers the cost of a procedure in advance. It's difficult to manage your expenses when the costs aren't known.

Bruce Peterson

Redmond, Wash.

I read your piece and, honestly, had to laugh out loud. The Post's ongoing coverage of health care continues to target workplace employees and the carpetbagging health care industry when, in fact, the people who need help are those in the middle to lower classes and, specifically, the self-employed.

Did you know that the Washington area contains the highest percentage of self-employed and contract workers in the nation? Not only are these people with small businesses, but mostly contract workers for government agencies or peripheral businesses. Our biggest expense, our biggest issue: health insurance.

The thousands of us who are sole proprietors in this region continue to wait for some action, some reporting, some perception and ingenuity on the behalf of health care for people like ourselves.

Dennis Tuttle

Silver Spring

Your article was slanted squarely against these new plans. You should have done a line-for-line comparison between the patient with the CDHP and a traditional PPO. Preexisting conditions apply no matter the plan design, therefore, it was very misleading to introduce non-covered costs due to preexisting conditions.

I agree that the administration gaps and differences require a committed education program, but I would also comment that the current system is unsustainable. Employers, especially small ones, can no longer absorb double-digit premium increases without shifting more cost to employees.

Patrick Mulkey

Employee Benefits Insurance Officer

BB&T Insurance Services Inc.


As Sy Syms says, "An educated consumer is our best customer." Kudos for shining a light on the darkness surrounding today's choice of health insurance plans.

Barbara Bellack

Executive Director

The National Alliance on Mental Illness

of Maryland

Glen Burnie

I didn't learn anything new from your article because I already know how bad these plans are. The logic behind them is that there is actually a health care market, like that for consumer goods, etc. There are three fallacies:

1. You don't usually jump from doctor to doctor (as in, I can go to Wal-Mart, Target, etc.). Continuity of care is a good and basic medical practice, so you go to the same doctor and pay what your doctor charges. Similarly, if you need another service, like an MRI, you just can't walk in, see the price and walk out. In fact, it's hard to get a price. It's even hard to know who to call to get a price.

2. When you go to the doctor, you don't know what you need. You may go in for a checkup, but then find you need tests, treatments, etc. It's difficult to ask, "What do you charge for this? Can I get another price and get back to you?"

3. The biggest fallacy is that there is a consumer market for medicine. The insurers are buying health care. Insurers negotiate. Insurers either know or set prices. Consumers don't have the information, and even if they did, aren't in a position to pick and choose.

Chuck Vukotich

Adjunct Assistant Professor

Graduate School of Public Health

University of Pittsburgh