Not surprising that sick people aren’t always happy about costs

It’s late and I’m out of time to dig deeply into this topic today, but I wanted to comment on the widely reported concerns about health care costs in Massachusetts among the sick, even though the vast majority of them have health insurance. The Boston Globe (For sick, cost can impede care) led off its story by saying:

“Fourteen percent of sick adults in Massachusetts were unable to get health care they needed in the past year..”

More than 70 perent said they couldn’t afford out-of-pocket payments or that their health plan refused coverage.

Of course it’s not great that people couldn’t get needed care. But from a policy standpoint it’s not clear that it would be better if the percentage complaining were 0 percent rather than 14 percent. We’re dealing here with a subset of patients –those who have been sick. Healthy people have very little contact with their health plan or health care provider, and they tend to be satisfied. Sick people –who are receiving insurance payouts– end up finding out that insurance doesn’t cover everything.

But compare the health insurance market to others. I’ve known people who lost their house or possessions to fire or theft, and even though they thought they were well insured it turned out that payouts were lower than expected or denied. It’s just the nature of insurance. If anything other forms of insurance are worse in this regard than health insurance, because they are freer to exclude scenarios that are likely to occur.

For the sake of overall cost containment, in some cases it may be ok that a health insurer doesn’t provide reimbursement. The poll relies on the respondent to define what care is “needed.” But can the average patient really do so?

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