The current build of MCC plans already calls for large deductibles. The recently enhancements to Health Savings Accounts provide a significant tax savings to any working person who pays taxes. Why not use the federally-specified High Deductible Health Plans as the pattern for MCC plans? These plans make drugs subject to the same deductible as most other expenses.

This heresy will get me in trouble with some, but the safety of orthodoxy will provide cold comfort to those who choose an MCC plan with absolutely no drug coverage or to a state agency responsible for dealing with too many waiver applications.

Our healthcare and our health insurance in Massachusetts is either the most expensive in the world or close to it. The MCC plans are intended to set a floor below which an insured person will be deemed in violation of a law whose functions are to expand access to healthcare and increase the affordability of health insurance.

As has been pointed out a number of times on this blog, insurance of any type first protects against financial loss that is indefinite as to the time of its occurrence and definite as to the nature of the risk covered. Neither Chapter 58 nor MCC plans endeavor to provide for payment of all medical expenses, nor should they. We may get to that point, but we are not there yet.

While listening to Connector Board members present views and advance arguments, it has become clear that there are those who believe MCC plans should first address prevention of the financial catastrophes of major medical expenses. Others have been equally steadfast in insisting that MCC plans provide low out-of-pocket coverages for some office visits and some drugs. If the choice were simply between these two categories–catastrophic coverage OR first dollar benefits—I believe the essence of MCC plans requires that it be the former. It may be true that catastrophe-only coverage may provide a disincentive for a covered person to seek care during the early stages of a severe condition, but no regulation or law can prevent this entirely. Ultimately, the individual citizen must decide whether to seek care or not. This imperative for prudence is inescapable, ubiquitous and entirely human.

If the final MCC plans were to cover only first dollar benefits we would have a situation that essentially endorses plans that are insignificantly different from the frequently-derided mini-med plans. No one on the Connector Board has proposed plans covering only first dollars.

It does seems that we are in danger of having MCC plans that are characterized by the pitfall of design-by-committee. After listening to much Connector Board debate I now understand how Medicare Part D plans acquired a “donut hole”: the only way to satisfy those demanding first dollar coverage and those insisting on catastrophic benefits was to exclude benefits in the middle.

It would be a pity to let MCC plan design fall victim to the same forces.

Business leaders represent their own best interests and we all have reason to consider that as we evaluate their letter to Jon Kingsdale. But there is nothing in that portion of the letter quoted here that does anything other than emphasize the need to make MCC plans affordable both now and in the future. Employers’ relationships with their employees are primarily financial in nature. It only makes sense that they should emphasize protection from catastrophes. The encouragement of preventive healthcare is laudable, but outside the purview of the employer and best left to the individual employee, especially where the coverage is “MINIMUM CREDITABLE”.