Nevertheless, when questioned about how they plan on controlling rising health-care costs in the future, the majority of respondents indicated that they intend to ask workers to pitch in. Toward that, many businesses are experimenting with defined-contribution plans such as health savings accounts. Like 401(k) plans, HSAs (and their predecessors, health retirement accounts) promise to give employees more control over their plans. But critics argue that taking money out of the system to fund the accounts of healthy workers will add more costs than it cuts.
What’s more, requiring employees to pay a hefty portion of their medical costs seems like the Rx equivalent of Russian roulette. Faced with a $5,000 deductible, workers may choose to forgo medical treatment; “well care,” the single surest way to control health-care costs, would go out the window for most.
Backers of HSAs — and that list includes President Bush — point out that the tax-free accounts can be invested. Since HSAs roll over, unused funds can be turned into something of a nest egg, which can be used to pay for medical bills when workers retire. The question is, Will employees manage their accounts wisely?
Hard to say. But since HSAs and other defined-contribution plans are modeled on 401(k)s, the answer may lie in how workers are managing those retirement accounts. And that’s troubling. According to experts, many employees are not diverting nearly enough of their salaries to the plans to retire comfortably. Furthermore, most workers simply aren’t savvy investors. Too many young employees, for example, put their money into safe vehicles like money market accounts, leaving the funds vulnerable to the ravages of inflation. And as the vaporized 401(k) plans of many Enron employees painfully revealed, lots of workers have no clue about diversifying their portfolios.
A Little Sanity
The wild card in all of this, of course, is the tendency for people to want to extend their expiration dates. The reality is, Americans will continue to live longer, stretching their retirements out for decades, not years. A graying population will put further stress on an already stressed-out system. Reining in medical malpractice will undoubtedly boost profit margins for doctors, but most experts believe tort reform will have a minor impact on overall health-care costs.
Universal health care would help take some of the costs out of the system, particularly expenses that arise from treating the uninsured. Indeed, some executives believe universal health care is the only answer to the health-care crisis in the United States. But given the yawning government deficit — and with Congress’s attention firmly focused on Social Security and Medicare — it’s not likely universal medical coverage is coming anytime soon.
Employers, therefore, will continue to bear the brunt of double-digit increases in health-care insurance prices. To reduce those premiums, corporate customers will have to put more pressure on providers to prove that products are both effective and cost effective. Technology, too, holds promise. Digitizing medical information will go a long way toward streamlining the system and creating price transparency. Down the road, insurers may figure out a way to put some bite back into managed care. Despite complaints from workers, HMOs brought a little pricing sanity to the medical-care system.
But there is a risk here. An aging population may well create a labor shortage. Then, employers that provide “Cadillac” plans, particularly medical packages with strong out-of-network coverage, will hold a decided hiring advantage over competitors with stripped-down HMOs.
Until then, expect the balancing act to continue. “I don’t want to see my employees not getting the care they need,” says the owner of a small public-relations firm. “But at the same time, if I keep paying more for health care, we’d go out of business. And then where would we be?”