All-inclusive

February 13, 2015

All-inclusive just doesn’t work in health care.

Recently, I took a somewhat-overdue trip to the tropics as an escape from the tender mercies of winter. Though such things aren’t generally my style, a hard-to-resist good deal turned up, and the week’s venue was an all-inclusive resort.

There are a few reasons why all-inclusive usually isn’t for me. High on the list is that I’m more about quality than quantity, and all-inclusive tends to accentuate the opposite. Since AI facilities collect a flat sum of money from guests rather than charging for specific menu-items, they have less incentive to serve lobster, filet mignon, and champagne than, say, hamburgers, tater tots, and low-end beer. (Happily, one of the reasons I chose to vacay where I did is that the place is something of an exception to this trend.)

Many vacationers have successfully developed an all-inclusive lifestyle, and eagerly set about gorging and guzzling from the moment of their arrival. Some don’t even seem to care that the fare is below the par they would expect if dining out at home, and/or relish the challenge to get their money’s worth. Others (especially newbies visiting all-inclusives for the first time) are unpleasantly surprised at how much they are paying in exchange for mediocrity.

Being occupationally entangled in the web of our health care system, I suppose it was inevitable that I would regard the all-inclusive environment around me as bearing certain similarities to it. Indeed, since passage of PPACA, it has become a legal requirement to enlist in a health care plan inclusive of all the things our presumably-wise policymakers have decided we should not be allowed to do without (for instance, maternity coverage for geriatric patients). Those choosing to do otherwise (a la carte, as it were, paying only for healthcare goods and services actually used or reasonably expected to be) are to be punished with a hefty tax/penalty.

Folks thereby hit with skyrocketing health care premiums were offered varying reassurance by proponents of this plan, not the least of which was that the more expensive insurance was “better” than pre-PPACA insurance, covering more goods and services. Yes, you were paying more up front…but now everything you could need was included![[{"type":"media","view_mode":"media_crop","fid":"32057","attributes":{"alt":"Eric Postal, MD","class":"media-image media-image-right","id":"media_crop_855208315019","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3391","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Eric Postal, MD","typeof":"foaf:Image"}}]]

And then came the zinger: No, it wasn’t. Copays still existed, and were often substantial. Then, there were the deductibles, which were suddenly reaching into the thousands. In other words, after being forced to pay more for all-inclusive health care, you *still* had to pay a la carte. (And somehow, all of this extra money was vanishing into the system, since, to my knowledge, docs never stopped getting their annual reimbursement cuts.)

Much like with all-inclusive hotels, I am sure there are plenty of insured who will rise to the challenge of getting their money’s worth out of the new system, getting every last service they possibly can from it. How this is supposed to bend the health care cost-curve is beyond me; I think the CBO has expressed similar doubts.

Vacationers who decide that all-inclusive venues are not for them (for whatever reason-higher cost, lower quality, etc.) tend to do what citizens in a free-market society can: Choose not to play the all-inclusive game, and take their business elsewhere. Such folks might scoff at fans of the all-inclusive option, and vice versa. Occasionally, someone from one camp might find himself sampling the other way of doing things, and be sufficiently impressed as to change preferences.

Perhaps, someday, those of us who wish to, will regain the right to make such choices for ourselves when it comes to planning for our individual health care needs.