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About a month ago from ISAHU's Twitter via CoSchedule

Is the problem with health insurance that it’s just not simple enough?

Woman working on computer

By Justin Harter, ISAHU Technology Chair

Remember when people used to burn DVDs and how hard it was to make a movie on your computer? In theory, it should have been simple in 2005 to move some footage from a camcorder, put it on a computer, do something with it, and make a DVD with music that you can play on your TV.

If you ever tried making a movie, it wasn’t easy. None of the software was very good, and video processing continues to be a taxing process for computers. Plus, you still have to combine some creativity to edit it all together. There’s a story from inside Apple about a meeting held between some engineers and Steve Jobs. They were working on what would become iDVD, their DVD-making software. The goal was software that would make the process of making a movie and burning it to a DVD easier.

The engineers had a lot of ideas for how to conjure options and menus, set up an interface, and guide people through the process. Jobs walked in the room and allegedly said it was all terrible. He grabbed a dry erase marker and drew a big empty box on the whiteboard behind him. “It’s going to be a single window. You drag your movies into the window and there’s a single button that says ‘Burn’.”

That was simpler, and it is largely what came to be iDVD. Except it still relied on people knowing how to get footage off a camera, where to drag and drop it to and from, and know how to format the disk for their DVD player. And heaven help you if you had a Windows PC.

I was wondering the other day if health insurance isn’t like making movies on your computer. Generally, people recognize health insurance shouldn’t be too hard. They go to an agent or the Exchange or their HR people and get the requisite options, pick one, pay it, and use it later.

But then they start looking at the options and configurations and realize it’s over their head. It uses words many don’t understand, or don’t fully understand. And, like some of you when confronted with an esoteric computer problem, you begin to shut down. “I’ll come back to this later,” you say, and then later never comes. Or if it does, you just reach out to whoever you trust most that knows a little something about it. That’s if you know someone or can pay for help.

Market forces being what they are, complexity is usually removed from the marketplace over time. Computers get simpler and more stable, like iPads vs. PCs. Cars get easier to drive with traction control. Airfare gets easier to shop for because websites can just search for everything everywhere and tell you the best option for where you want to go.

Health insurance hasn’t had that moment yet. The Exchange was a step, of sorts, in compiling a bunch of options together for individuals. But no site exists where Joe Hoosier can just say “I’m a single 38-year-old white male, I earn $42,000 a year, I have some knee pain, I travel a lot for work, everything else is healthy. Tell me what to buy.” When that happens, the market will be easier because it’ll remove everyone’s need to understand what a network is or co-pays and deductibles, and how it compares. It’ll be like how most people buy shoes: women’s size 8, white, sneakers, red accent, arch support, under $75. Or computers: laptop, 13” screen, good for email and word processing, under $1000.

This comes with obvious downsides, of course. For one, the options tend to get so simple people who understand all of it get irritated at the lack of configurations and preferences. But the market has clearly shown in every other industry people don’t care. Or at least, not enough people care. After iDVD was released for Macs, people used it, but it was never a hit. Most advanced users thought it too simple. Everyone else still thought it was complicated. Eventually, software on our phones made it so we just let it create movies for us automatically based on whatever photos and clips we have. We just skipped over that DVD problem entirely.

It’s not hard to imagine a world where health insurance takes the same path: it’s complicated so someone tried to make it simpler. Except it was still time-consuming and confusing to most people who have kids to feed, a career, laundry to fold, papers to review, and a lawn that needs mowing. So what’s next? Single-payer? Market-driven software that just tells people what’s best for them? Some other market force? Time will tell, but politically the one thing single-payer has going for it is that it’s simple, and simplicity sells. “You get a card, go to the doctor, and get care.” The end. There are a lot of gotchas and complexities in there of course, and it costs a lot, but to the end user, that message is the big empty box on the whiteboard with a button that says “Get care”.

Remember, too, with burning movies to DVDs, the goal was never the DVD itself. It was preserving a memory with some fun effects and music. We just moved beyond that to other things, like Facebook memories or Photo Memories on your phone. Likewise, health insurance isn’t about preventing loss. It’s about getting access to a doctor to fix or prevent a problem. Unlike DVDs, however, we’re not going to move into a world where no one needs healthcare.

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Indiana State Association of Health Underwriters

Indiana State Association of Health Underwriters