In this episode, we were joined by Aspen Institute Healthcare Innovators Fellow Deb Gordon, author of The Health Care Consumer’s Manifesto. Deb is a seasoned health insurance executive, and her research and writing have fueled her passion for helping Americans become savvy health care shoppers. We talked about how employers and brokers can help reduce healthcare costs by giving consumers expert guidance so they can feel confident as they shop for plans and healthcare services.
Understanding the U.S. healthcare system
Deb’s career journey started in academia, where she studied bioethics and public health and found her passion for consumer insights. That academic foundation has informed her career and how she thinks about understanding consumer behavior. Deb went on to be the Head of Marketing for a Medicaid health plan, where she saw first-hand some of the issues people faced in shopping for and using health plans. She found that it’s hard to make insurance easy, because it simply isn’t. But there’s more to be done to help people buy and use it well.
Deb took her dissatisfaction with the current U.S. healthcare system and turned it into action. As an Eisenhower Fellow, in 2013 she went to Australia, New Zealand, and Singapore to better understand their health systems. She found that in Australia and Singapore, consumers play a bigger role in their healthcare coverage than in the U.S. There is more widespread use of savings plans and consumers have more say over their spending, but there is also more of a sense of partnership with the government. In the U.S., we haven't set up our health systems that way, in part because of cultural and political differences. We continue to have a system that focuses highly on individual responsibility and doesn’t have a strong sense of partnership with the insurer.
The impact of cost-sharing on rising healthcare costs
There was a time that many people thought that higher cost-sharing would incentivize U.S. consumers to shop for less expensive healthcare and utilize their plans more efficiently, thus reducing costs. But it hasn't worked out that way. Over the past decade, more and more cost-sharing responsibility has ended up on consumer’s shoulders, in both ACA and employer-sponsored plans. The average deductible in 2019 for an individual plan was $1,931, and for a family it was $3,655.
As a fellow at the Harvard Kennedy School in 2017, Deb saw that cost-sharing had risen, but nothing else had changed with it. Consumers were not more savvy or invested in their healthcare. Costs continued to rise, while cost-sharing suppressed utilization overall. Consumers have difficulty distinguishing between appropriate and inappropriate utilization. Couple that with a fear of unexpected costs, and people are avoiding care, even if that care is essential to their well-being.
How employers can help reduce costs and foster goodwill
As employers shift rising health plan costs to their employees, employees are aware that the value of their benefits has eroded over time. They blame policymakers and they blame their employer, leading to an erosion of goodwill in the workplace.
However, there are some positive ways that employers are dealing with rising costs to help their employees. One example is a reimbursement program, where employers offer to pay up to a certain amount of a plan’s deductible. It does add some costs back in, but it can still be beneficial because while only some employees will use this perk, it acts as a safety net for everyone and helps to reduce financial anxiety.
Another way that employers can help is by providing expert, personalized advice as employees shop for plans. Data shows that the vast majority of employees overbuy health insurance. Some people buy more coverage than they need because of uncertainty or fear, and some are confused about their options. An employer can help by providing resources, like access to an expert broker, who can help employees make economically rational decisions before they buy.
Another option is to provide additional benefits, like Ansel, that can help employees with unexpected healthcare costs. Supplemental insurance is an alternative to an HSA or an expensive low-deductible plan that can yield cost-savings while still providing better coverage. A solution like Ansel can work in tandem with other interventions to help give employees more peace of mind.
Finally, employers can turn the lens on themselves and figure out how to make their workplaces physically and mentally healthy environments. COVID-19 has intensified mental health burdens, and as we come out of the pandemic, we may see more issues surface as people cope with their experiences during the past year. Employers can do a lot to make sure they foster kindness, compassion, and humanity in their workplaces. We are people when we go to work, and we are people when we go home. It’s time to make sure we recognize our mutual humanity at work so we can foster healthier teams and relationships.
What’s next for Deb: Financial vulnerability index
In the rest of 2021, Deb plans on revisiting a project that the pandemic put on pause: working on developing a financial vulnerability index. Healthcare and financial well-being go hand-in-hand. The pandemic amplified awareness of how these two topics are interrelated, but there’s still room to increase public understanding of the specifics. Deb plans to develop a financial vulnerability index with the goal of better understanding how health consumers make financial decisions and creating solutions for some of the issues people face in this arena.
“One of the things I've learned in my career... is that people with all the resources available to them can still feel vulnerable. Vulnerability can be tangible—folks who don’t have money or access to information or access to care—but it’s also a state of mind.”
Listen to the full episode to hear more from Deb.
Deb’s resources
Deb recommends the book The Healing of America by T.R. Reid, calling it “one of the best healthcare books I’ve ever read.” It is a comparison of health systems around the world, told in a narrative style. The book delves into the structure of different healthcare systems and the cultures behind them.
You can find Deb on Twitter @gordondeb, writing for Forbes, and at debgordon.com.
Note, this episode is for informational and educational purposes only. Deb Gordon is not compensated, affiliated with, nor compensated by Greenhouse Life Insurance Company.
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