Ask any employee if something is wrong with the health care system, the answer will almost assuredly be “Yes”. Ask them how to fix it and the answers will cover the entire spectrum, varying from completely free health care to a completely free market. The fact that the health care industry needs to be fixed is no secret, but there is no clear answer on where to start.
« This is something Millennials will have to accept – regular upkeep and tracking of health is essential to a long life. » Chris Lombardi, Senior Associate, Health.
The need for change is clear – claims are simply way too high and unsustainable over the long haul. But while all the so-called “adults” in Washington are arguing over solutions to the real problem of costs, another group of Americans – we, the Millennials – are discussing the problem from a very different perspective.
Millennial misconceptions
Here’s just a sampling of the perceptions – perhaps based on some observed traits – of humans born between 1983 and 1997 – according, that is, to article after article: We complain a lot. We’re too spoiled. We need instant gratification, and we need it now! Even when it comes to the divisive topic of health care, we find a way to make it about us and steer the conversation in a different direction. Health care isn’t convenient enough. It’s not online. It’s too expensive and I don’t need it anyway. Millennials have now officially become a larger group than the Baby Boomers and as we become more and more vocal, our opinions hold more and more weight. No matter how off-base our complaints may be, if the health care industry wants to succeed, we strongly suggest they start listening to what we have to say… but some would say they already have.
Why? We are never satisfied. The whole heath care industry can bend over backwards to please our palates, but we will always ask for a finer flavor (I’m pretty sure that’s why Umami was added to list of tastes). The truth is, the health care industry has responded to a lot of our demands, and while it still is far from perfect, there’s enough to be grateful for now to warrant a little bit of patience and see what will be done with the rest.
Convenience? Too little, too late
The main complaint among Millennials is the lack of convenience. The age of technology is upon us and with so much information available in an instant there is always somewhere to go, something to do, and more to learn. We don’t have time for lunch, let alone an hour phone call with a receptionist, followed by 2 hours in a waiting room filling out forms, before a 3-minute meeting at which time the doctor tells us we’re fine, which is then followed by the inevitable $150 bill. Our mind set is simple – If I’m not sick, I don’t need to waste my time and money to see the doctor. I can just go on WebMD and diagnose myself.
The problem with this mind set is also simple – it’s wrong.
The exponentially rising health care costs are predominantly driven by treating chronic diseases after they are fully developed. The real costs kick in once the person hits the “point of no return” and needs his cocktail of prescription drugs every day just to be able to get out of bed and go to work.
A big portion of the PPACA legislation that went into effect in 2009 was to change the focus from treatment to prevention—the idea being if we incurred a little more cost up front to cover regular tests and screenings, chronic diseases could be identified early or even prevented and large treatment costs can be avoided all together. This is something Millennials will have to accept – regular upkeep and tracking of health is essential to a long life. At the same time, the health care industry needs to “engage” us in preventive care and make these regular checkup visits more convenient, particularly for those who are juggling work, school, and/or young families. A number of people have identified this need in the market and pounced on the opportunity.
Yes, but…
We said scheduling an appointment was too difficult. Over the last decade, numerous online portals have been developed showing interactive calendars of all available time slots for each doctor. They even have smart phone apps to book appointments on the go. We said finding a doctor that was covered under our specific insurance was too complex. These websites show doctors that accept insurance from hundreds of companies and even includes filter functions so you can see all doctors that are available under your plan and sort by their ratings provided by other patients. We said we’d rather suffer from sickness at home than be stuck in another waiting room with the same toys only doctors’ offices seem to have. Not only can you check in online and fill in all necessary paperwork ahead of time, but you can save your information to your profile so that it automatically fills in the next time you book an appointment.
Many doctors are still hesitant to join the revolution, but coverage is rapidly growing – one portal claims to cover 40% of the United States population across 2,000 cities. If you live in a major metropolitan area, you may not get the specific doctor you’re looking for, but you can bet you will find a comparable alternative . Health care scheduling is finally starting to integrate with the internet and looks to take all the hassle out of booking an appointment – but getting these kids to the doctor is another story.
Signing up for and booking an appointment online is free, but we all know there will be a bill at the end of the visit. This is unavoidable, but given the well-documented financial pressures most Millennials are struggling with, we don’t want to be further bogged down with large health insurance premiums and out-of-pocket costs.
With all these money worries, we don’t want to be further bogged down with large health insurance premiums. We understand that coverage is now mandatory, but you can bet we will search high and low for the cheapest plan – which would be the High Deductible plan….
Vicious cycle
Commonly known as “Catastrophic Plans,” High Deductible Health Plans (HDHPs) satisfy the new individual coverage mandate included in PPACA, but do not offer great benefits if one actually uses the plan. The deductibles are set high so that most of the risk is put on the people insured, almost incentivizing them not to go to the doctor for fear of large out of pocket costs – thus continuing the vicious cycle of avoiding the doctor to avoid spending money while incurring greater future costs from diseases that were left untreated.
This also defeats the whole “risk sharing” idea of insurance– a system that needs everyone paying adequate premiums to cover the large costs of the small subset of people incurring claims much greater than the premiums they are paying in… whether those claims are related to car crashes, house fires or health care services. If Millennials are only opting for the cheapest plans, they are not contributing as much is needed to keep the system in balance. Eventually, without us healthy people paying adequate premiums into the pool, the large claims of the few will bankrupt insurance companies across all America.
Now, while I do work in the employee benefits industry, I don’t claim to be a health insurance expert (yet), nor do I fully understand how the whole system works, but I am a Millennial, which means I have an opinion – and it will be heard.
Checkup or pay up
We’ve seen that the main influence over the decisions of Millennials is money, so I think we start there to encourage them to go to the doctor. Insurance premiums are continually increasing as underlying health care costs increase, but what if there was a penalty for not going to the doctor? What if your premium doubled if you did not go for at least one regular checkup each year? And what if this was put in bold, red, size 46 font on the front page of all insurance papers? Every New Year’s Day there would be a line out the door for people to get their checkup out of the way and make sure they do not pay the huge fine associated with missing a doctor’s visit.
The problem of rarely going to the doctor is exacerbated by the fact that Millennials tend to see a different doctor each time, based on convenience. This is a huge detriment to the quality of care the doctor can provide. Most diagnoses are identified by noticing something out of the ordinary – a change to what is normal for that patient. If there is no relationship with a single doctor, that “normal” is never defined so deviations can be easily missed. My idea is similar to a disappearing deductible, but includes a disappearing copay with one stipulation – you have to see the same doctor. The copay would be initially set rather high, so the cost of the first visit at any doctor’s office will be expensive. Then, for each additional time you see that doctor the copay becomes smaller and smaller. This will keep patients and doctors together for longer so that “normal” can be well defined and abnormalities can be more easily identified.
Are these ideas perfect? I don’t know. Like I said before, I do not claim to be an expert. But these are the problems of Millennials, and we are not going away.
At the same time, some people have listened and responded admirably. Health care is finally beginning its integration with the internet, offering a level of convenience that was never available before. While much more progress needs to be made, at least it’s a start.
American health care, you’ve bought yourself some time with this Millennial. But what happens if time runs out?