"No Physician Would Design a $10,000 Deductible"

Sometimes the sharpest line about health care isn't in the article. It's in the reader mail.

In KFF Health News' Oct 19 letters, Clay Johnston of Austin, Texas, responded to a story about health care workers priced out of their own coverage. One person in that story kept her insurance but waited weeks to see a doctor because of a $10,000 deductible.

Johnston put his finger on why:

"Doctors design care. Insurers design coverage. The two are put together in separate rooms by different teams, measured on different things, then handed to the same person as if they were one plan."

Then the line every benefits broker should have taped to the monitor:

"No physician would design a $10,000 deductible; it just blocks people from investing in prevention and getting care early. But no physician was in the room when that threshold was set."

He's right. And he isn't describing a bug in the software. "That tension is not an accident," he wrote. "It is how the system was built."

You can see that tension play out in exam rooms every week. A man in his 50s notices he's thirsty all the time and waking up twice a night. He knows he ought to get it checked. He also knows the office visit and the blood work will hit his deductible at full freight. So he puts it off until spring. A clinician may say, "This is what you should do next," as Johnston put it, while the benefit design hands the patient a financial penalty for listening.

Waiting is the expensive choice. It just doesn't show up on the ledger until the complication lands in the emergency department.

Johnston's answer is to design coverage and care together. Direct primary care does that right now, at the scale of one patient and one physician.

If you're picking a high-deductible plan this fall because it's the only monthly premium that fits your budget, don't let that deductible ration your primary care. Pair it with a direct care membership. The office visit, the A1C check, the follow-up call, and the "this is probably nothing, but let's look" happen without touching the deductible. Your major medical plan stays in the drawer for surgery or a hospital bed.

A doctor designed the membership. You can tell the first time you use it.

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