Got a high-deductible health plan? The kind that doesn't pay most medical bills until they exceed several thousand dollars? You're a foot soldier who's been drafted in the war against high health costs.
Companies that switch workers into high-deductible plans can reap enormous savings, consultants say - and not just by making employees pay more. Total costs paid by everybody - employer, employee, and insurance company - tend to fall in the first year or rise more slowly when consumers have more at stake, whether or not they are making medically wise choices.
Consumers with high deductibles sometimes skip procedures, think harder about getting care, and shop for lower prices when they do seek care.
What nobody knows is whether such plans, also sold to individuals and families through the health law's online exchanges, will backfire. If people choose not to have important preventive care and end up needing an expensive hospital stay years later as a result, everybody will be worse off.
A new study delivers cautiously optimistic results for employers and policymakers, if not for consumers.
Researchers led by Amelia Haviland at Carnegie Mellon University found that overall savings at companies introducing high-deductible plans lasted for up to three years. If there were any cost-related time bombs caused by forgone care, at least they didn't blow up by then.
And the savings were substantial: 5 percent on average for employers offering high-deductible plans compared with results at companies that didn't offer them. And that was for the whole company, whether or not all workers took the high-deductible option.
The size of the study was impressive; it covered 13 million employees and dependents at 54 big companies. All savings were from reduced spending on pharmaceuticals and doctor visits and other outpatient care. There was no sign of what often happens when high-risk patients miss preventive care: spikes in emergency-room visits and hospital admissions.
The suits in human resources call this a "consumer-directed" health plan. It sounds less scary than the old name for coverage with huge deductibles: catastrophic health insurance.
Making smart choices
But having consumers direct their own care also requires making sure they know enough to make smart choices like getting vaccines, but skipping dubious procedures like an expensive MRI scan at the first sign of back pain.
Not all employers are doing a terrific job. Most high-deductible plan members surveyed in a recent California study had no idea that preventive screenings, office visits, and other important care required little or no out-of-pocket payment. One in five said they had avoided preventive care because of the cost.
The Carnegie Mellon study also doesn't address a side effect of high-deductibles that doctors can't treat: pocketbook trauma. Consumer-directed plans, often paired with tax-favored health savings accounts, can require families to pay $5,000 or more per year in out-of-pocket costs.
Three people out of five with low incomes and half of those with moderate incomes told the Commonwealth Fund last year their deductibles were hard to afford.
As in all battles, the frontline infantry often makes the biggest sacrifice.