The Vail Valley Partnership has long advocated for multiple solutions to the high cost of health insurance in Eagle County and across the mountain region. We commonly call for a “yes, and” approach: address provider costs, find legislative solutions and hold insurance companies accountable; those pointing fingers at any one part of the equation while ignoring the others are missing the bigger picture.
Answers are not easy, and change will come from a “yes, and” approach. Originally developed in an improv comedy setting, “yes, and” can also be applied to business. In a business or problem-solving setting, saying “yes” encourages people to listen and be receptive to the ideas of others. Rather than immediately judging the idea — judgment has its place later on in the development process — one should initially accept the idea, which enables the discussion to expand on the idea without limitations. The next step in the process is to add new information into the narrative, hence the phrase “yes, and.”
It is in the spirit of “yes, and” that we developed the One Valley Healthcare Program and support the idea of health care sharing programs as one part of the solution to high health insurance costs.
Consider some of the possible benefits to cost-sharing programs:
• Tremendous value: Instead of paying monthly premiums to an insurance company, members share a set amount on a monthly basis and are provided community funds as medical needs arise. Through this model, members typically see their total health care costs drop by up to 60 percent.
• Freedom of choice: Members and their families are free to choose the providers of their choice. This allows access to your choice of provider without increasingly common out-of-network fees.
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• Additional member services: In keeping with the model of health care sharing, member services include medical bill negotiation with a personal member advocate, expert second opinions, prescription drug plans and counseling services.
Perhaps the biggest disadvantage in the traditional health insurance model is the concept of insurance itself: Transferring the risk to an insurance company in exchange for the payment of a premium. Most insured individuals have no incentive to care how much the insurance company has to pay for a claim. Once the co-pay and deductible have been paid by the insured, the financial responsibility has been met and the remaining balance is of no concern to the insured. Health care is the only industry I can think of where the consumer is oblivious to the cost: A $5,000 service could cost $1,500 next door; however, both have the same co-pay – and the customer never knows and has no incentive to shop around.
However, cash payers will not pay $5,000 for an MRI when they can go next door where the cost is $1,500; even if their maximum out-of-pocket is $500. The balance of $4,500 or $1,000 is paid by the community. The less the community has to pay, the less the individual members will have to pay in their monthly shared amount. The program incentivizes members to be consumers in their health care.
Medical cost sharing is not insurance where a premium is paid, and the risk of major medical expenses is assumed by the insurance company. Second, the patient becomes a responsible, cost-conscious consumer rather than only being responsible for a co-pay and no concern what is charged to the insurance company.
Answers to big problems are not easy, but we believe health care sharing is a part of a “yes, and” approach to meaningfully address the issue.
Chris Romer is president and CEO of the Vail Valley Partnership, the regional chamber of commerce. Learn more at http://www.vailvalleypartnership.com.
