What Trump should really do to fix health care

I recently announced to a family: “I have great news, mom, your child does not need surgery!” Instead of cheers of joy or happiness, I noted tears running down mom’s face. She sadly shared with me that she just wrote a check for $1,000 out of her pocket for her child’s test, because of a high deductible plan.

Last week, I recommended surgery to another family and they politely declined and asked if the surgery can be postponed until the end of the year, again because of a high deductible plan. This is now the new norm of the American health care system.

Approximately 12 years ago a new strategy called “consumer driven health plans,” or CDHP, was introduced by insurance companies to control their costs and to make their industry more profitable. The main goal is to force patients to pay “out-of-pocket” a substantial amount of dollars before their healthcare coverage plan kicks in; “skin in the game,” the insurance industry calls it.

On the surface, these CDHPs are attractive because of their lower premiums. However, what the people did not understand was that lower premiums really meant less insurance coverage for their families. If you believe in the Loch Ness monster, you may also believe that by you sharing in the cost of health care, taking more control of medical decision like shopping around for cheaper procedures and doctors that your medical bills should also be lower.

But in reality, because of high deductibles, patients delay, skip office visits, wait until they are sicker, forgo their medications and then end up with bigger medical bills in the end. If deductibles are higher than $1,500, 30 percent of patients will skip tests, treatment, medications. In effect, this is a form of rationing medical care and services, or at the very least these practices lead to potentially bad medical choices.

A recent survey revealed one in four patients with a CDHP went without care because of lack a cash to pay out-of-pocket costs, with most patients commonly skipping tests, treatment and follow-up visits. In fact, if a household makes less than $50,000 a year, three-quarters of these families have difficulty coming up with $1,000 for an emergency medical bill. Even for the families making between $50,000 and $100,000 per year, two-thirds of them will have the same difficulty.

These CDHPs are devastating moderate to poor income families whether they have coverage through the Obamacare marketplace or through their workplace employers. In fact, CDHPs are now permeating employer-based insurance plans nationwide. An employee may have an income of $40,000, but face a medical deductible of $10,000, or a full quarter of their salary. This is insanity. Indeed, CDHPs make the patients pay more, not just skin, but bones and flesh in the game.

Instead of repealing the Affordable Care Act which has contributed immensely to bending the arc of health-care injustice, Donald Trump should join efforts to improve the ACA. He could do so by addressing the unconscionable high-deductible plans that damage real lives, both Republican and Democratic, instead of repealing it. Doing anything less will only make America sick again.

Donald Nguyen, M.D., is one of our regular community contributors.

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