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Busting the "Shopping" Myth at the Heart of the Health Care Debate

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By Kelly Conklin, owner of Foley-Waite Associates in Bloomfield, NJ

I am a cabinet-maker. Want to know something, anything about wood, and wood products? No one can put you to sleep with woody facts faster than I can.

Now, there are people who know health care and health insurance like I know wood. For the last couple of years, as I have tried to grasp the complexity of the issues surrounding improving America's health care system, such experts have lulled me into dreamland on more than one occasion.

The truth is, the health care debate entered its own rhetorical dreamland way back in the Clinton administration. In Health Care Dreamland, we all "shop" for a plan that meets our individual needs, weighing "useful information" to make "informed choices" to get the best plan our money can buy. In this dreamy place, "no one stands between us and our doctors as we choose the best course of treatment." It's a "system" created and managed by the magical private sector, where "efficiency" and "quality" rule righteously over the land and we lucky "shoppers" get "the best health care in the world."

And, if the critics are to be believed, the Affordable Care Act signed into law last spring is solely responsible for turning that dreamland into a nightmare where all that good stuff is taken away.

Here's the rub: all that good stuff never existed in the first place.

"Useful information"? You mean those explanations of benefits that are loaded with fine print and still as thick as an old phone book? The ones you usually get only after you sign up and cut your first premium check? That may be information, but it sure as heck ain't useful. What about "informed choices," "efficiency," "quality?" They're all part of the shopper mythology. They existed only as a fantasy, at least for small business and individual buyers of health insurance like me.

Here's what really happens.

Once a year, I make what may be a life and death decision for my employees and me. I purchase our health insurance plan. Their only choice is to participate or not. One way or the other, they're taking their chances. I base my decision on cost because the product is so expensive and the criteria by which I might judge the "best" alternative are almost impossible to decipher.

Because our business is based in New Jersey, a state with decent consumer standards, the plans available here include many of the consumer protections in the Patient Protection and Affordable Care Act, meaning junk insurance isn't likely to be sold here. That said, every year the list of doctors participating in the plans we can afford has gotten shorter. So much for choosing our doctors. And every year the cost of deductibles has gone up. So much for discussing the best care option with those new doctors we just found.

We use a lot of reassuring language to talk about our broken health care system. Take the word "shop," for example. In my business, I shop for wood: last month we purchased FAS, 4, 6 and 8 quarter Poplar. Every lumber yard that quoted me was quoting to the same industry standard, meaning when the lumber was delivered it would all be pretty much the same, regardless of who supplied it. I was shopping based on price and service: who could deliver my material fastest, and at the best price.

Whether I'm buying lumber or bread, universally accepted standards assure some measure of quality. Read the label or know the standard and you are pretty much assured of getting what you pay for, nothing life or death about that. If only purchasing health insurance were that simple. But it's not.

When the Affordable Care Act is fully implemented, junk insurance will be harder to sell anywhere, especially if states set high standards for the state-based insurance exchanges the law requires them to set up. The goal of these exchanges is to create a real system for the sale of health insurance, not unlike the one I buy lumber in.

Whether quality insurance is affordable and accessible to small businesses in any given state will depend on whether the exchange in your state negotiates with insurers on prices and benefits, using the bargaining power of its participants to get the best deals. This is called active purchasing.

Is the health care law perfect? Of course not. But is it an opportunity? Absolutely. It's time to put aside the rancor and the politicking and roll up our sleeves to make the law work for us. If we don't, we can be darn sure who it will work for after the insurance industry's lobbyists are done warping it.

At this very moment, states should be busy setting up their health insurance exchanges, the single most important feature of the new law for small businesses and individual purchasers. That means everyone that buys health insurance, pays a co-pay or deductible, or obtains the services of a doctor or clinic should be paying attention and pressing their state representatives for high consumer standards and active purchasing.

Now more than ever, the language we use and how we use it can determine whether we achieve meaningful progress on health care reform. This time around, putting substance over rhetoric can be the difference between life and death for small businesses and our employees.

Kelly Conklin co-owns Foley-Waite Associates, a custom woodworking business based in Bloomfield, New Jersey. He serves on the steering committees of the New Jersey Main Street Alliance and the national Main Street Alliance network.

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