In just a few weeks, when the calendar flips to 2013, millions of Americans will get their first taste of Obamacare a $2,500 cap on their flexible spending accounts.
Thats down from the previous $5,000 cap and thus equivalent to a tax hike for any family that had been putting more into their FSAs to cover out-of-pocket healthcare expenses. But its also emblematic of a more troubling problem with Obamacare its undeclared war on consumer-directed health care.
To cope with runaway health costs, businesses have been increasingly experimenting with health plans that put patients in the drivers seat giving them more control over their care while making them more aware of the cost of the care they consume.
FSAs arent the only example of this consumer-directed trend. Consider the explosive growth of health saving accounts.
In combination with a high-deductible insurance policy, these tax-free savings vehicles allow patients to save money for routine healthcare expenses and to roll over tax-free to the next year. HSA-style plans barely existed in 2005; today one in five workers is enrolled in one, according to the Kaiser Family Foundation.
Rather than encourage this trend, Obamacare is trying to eliminate HSAs.
The law makes it more difficult for Americans to take advantage of HSAs by requiring people to purchase more generous insurance policies that cover so-called essential benefits. This mandate will boost premiums and leave many consumers with less money to save in their HSAs.
The essential benefits rules will also outlaw many existing high-deductible policies.
The growth of FSAs and HSAs has fueled other patient-centered innovations. Consumers are now demanding that providers offer better services such as telephone consultants, walk-in retail clinics, and on-demand laboratory tests at lower prices. Retail clinic RediClinic, for instance, says that its prices can be half those of a traditional doctors visit.
Obamacares mandated benefits will undermine these consumer-driven offerings, too. The rules will make consumers less conscious of the cost of health care so theyll be less inclined to seek out lower-cost health services. Thats bad not just for patients but for the overall healthcare system, which is suffering under the weight of escalating costs.
New information technologies are also empowering patients to exercise greater control over their health care. The Internet offers an ever-increasing amount of healthcare resources to patients, from symptoms checklists to information on treatment options, doctor ratings, and even end-of-life care.
For example, a site called MyDirectives.com lets consumers create and update advanced medical directives. The idea is to help patients delineate a clear end-of-life plan, including audio and video messages. The directives are available online anytime and anywhere in the world.
Thanks to this technology, doctors, hospitals, and insurers will be able to find out exactly what sort of care a patient in a coma, for instance, wants. Equally important, such directives will relieve family members of the guilt and angst that can plague them as they try to decide the best course of treatment for their loved ones.
End-of-life care is among the most expensive parts of Americas healthcare system. Its often so costly because families dont know what to do so they try everything. Communicating patient intent ahead of time can avoid costly and painful end-of-life episodes.
Tools like these put control over health care in the hands of doctors, patients, and families. In the process, they can help save the healthcare system money.
And yet, Obamacare is focused on taking control away from patients.
Take its $3.8 billion in spending on comparative effectiveness research (CER). The goal of such research seems harmless enough find out what treatments are most effective for the largest group of people.
But its a recipe for cook-book medicine, where the government can pressure doctors into prescribing treatments according to average results rather than an individual patients needs and preferences.
The law forbids a new government-chartered CER entity from dictating coverage mandates or reimbursement levels, based on its findings. But Obamacare also states that such a prohibition should not be construed as preventing the Secretary [of Health and Human Services] from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive program.
New accountable care organizations (ACOs) for patients covered by Medicare are another way that Obamacare tries to wrest control from patients.
ACOs are integrated networks of healthcare providers that can theoretically coordinate a patients care and thereby eliminate wasteful or duplicative procedures. In reality, theyre HMOs by another name and they give doctors a strong financial incentive to provide less care. Patients may not know if their doctors are withholding treatment because its unnecessary or because theyre trying to pocket more money for themselves rather than having to pay it back to the government.
The tragedy is that President Obama is forcing his centralized approach to health care on consumers just as theyre demanding more autonomy and as the tools that empower them to do so are coming online.
As the federal government tries to appropriate ever-more of peoples healthcare decisions for itself under the auspices of Obamacare, perhaps patients will fight back.