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That Darn Mitt I

Posted by John McDonough  February 1, 2012 03:30 PM

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So this morning I'm listening to Morning Joe on MSNBC and on comes our former Governor and current Republican Presidential candidate Mitt Romney. Joe asks him about Medicare (more on that in my next post). Mitt answers that he supports Cong. Paul Ryan's Medicare proposals to turn the program toward premium support/vouchers. Then he also says that we need to do better in controlling the rise in private health care costs, and that he has answers, two of them: first, more health savings accounts and second, more "coinsurance."

Health savings accounts (HSAs) are insurance policies that typically expose enrollees to higher deductibles, co-payments and co-insurance than traditional health insurance policies. Co-insurance is a form of insurance cost sharing where enrollees are responsible for a set percentage (eg: 5, 15, 25% or more) of an entire medical bill. Both HSAs and co-insurance are principal devices to expose patients to direct medical costs to reduce their use of medical services, whether necessary or unnecessary.

Later this morning, I received an email from the Robert Wood Johnson Foundation detailing new research on the impact of high-deductible health plans (HDHP) on families with chronic health conditions: "Delayed and Forgone Care for Families with Chronic Conditions in High-Deductible Health Plans." (One of the co-authors is my HSPH colleague Meredith Rosenthal.) Here are the reported results:

Results: Respondents included 208 families in HDHPs and 370 in traditional plans. Membership in an HDHP and lower income were each independently associated with higher probability of delayed/forgone care due to cost. For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes >400% FPL]. Similar associations were observed for children. 

Conclusions Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care.

So, Mitt Romney's approach to controlling private sector health spending growth is to continue and to accelerate the shift to insurance policies that expose patients to higher and higher levels of cost sharing. This reflects a view, popular among conservative health economists, that health insurance should, as much as possible, resemble auto insurance, where you only get help for catastrophic events.


No other advanced nation exposes their citizens to the levels of cost sharing and financial risk experienced by Americans now. And we have the highest health care costs, by far, among all industrialized nations. Mitt wants more of the same.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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