One of life's great mysteries is how really dumb people are able to function in society. You've probably asked yourself that question a million times – when the price of your groceries is $15.51, you hand the cashier $16.01, and she hands the penny back to you because she thinks you gave her too much money; when the sign says the left lane is closed half a mile ahead but people wait until the last 100 feet to put on their blinkers; when you do the math for your clients to show them they're clearly overpaying for health insurance but they're still too scared to give up the copays.
There was a 2006 movie called "Idiocracy" that tried to explain this phenomenon. The movie's narrator explains after thousands of years of evolution, man no longer has any natural predators. And because smart people often wait longer to have children, we're experiencing a sort of anti-selection where stupid people out-breed intelligent people, resulting in the dumbing down of society. Ridiculous, but it's easy to find yourself nodding in agreement.
So if people really are as dumb as they act, how can we possibly, in good conscience, sell them a consumer-directed health plan? Can they really figure it out? And if not, is it our fault for recommending it? In other words, should we sell our clients a more expensive product with higher out-of-pocket exposure because they're not smart enough to understand an HSA?
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The answer to this question depends at least in part on what the default is – if you don't offer them the HSA-qualified plan, will they actually purchase the more expensive copay option, or are they more likely to decline coverage altogether? Many people, unfortunately, choose to go without coverage because they can no longer afford the policy with first-dollar copayments, and their broker didn't show them a consumer-directed option. True, these folks might have had some trouble "shopping around" for health care, but don't uninsured people have the same challenge? At least with the high-deductible health plan they're protected from large out-of-pocket expenses.
Perhaps the trick is to change the way we're explaining the plans that require more consumer involvement. Instead of a long, complicated explanation about the rules and regulations of HSAs and the benefits of comparing cost and quality when shopping for health care, why not say something like this: "Plans that try to cover everything are really expensive, and many consumers find they don't actually use most of the services they're paying for. What I would recommend is a high-deductible health plan. It's less expensive, you'll still be protected if you have a large, unexpected expense, and as a bonus, you'll get discounts on things like doctor visits and prescriptions and can even pay with pretax dollars if you'll open a special type of bank account called an HSA."
The fact is most of our clients aren't really dumb – after all, they have managed to make it to adulthood in one piece and probably do things in their job we wouldn't understand. We just speak a different language than they do – one with way too many acronyms – and if we truly want them to understand, it's probably more effective to translate our message into their language than to try to teach them ours.
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