二十年前，几乎不存在高额免赔健康计划。今天，more than half of the U.S. workforce是一项，是每个人的自付额超过1300美元的计划，一个家庭为2,600美元。
It’s a growing, undiscussed problem for public health. Most doctors have had patients refuse treatment due to out-of-pocket costs caused by their high deductible health plan. All the while medical debt continues to grow, an issue that impactsmore than 50 percent美国人。
一项研究的研究证明，高扣除健康计划（导致更高的自付费用）可能不利于人们的财务福祉，尤其是那些患有慢性健康问题的人，例如diabetes and cardiovascular disease.
医生知道这一点。一个小秘密，没有广泛传播，是majority of doctors (me included) do not choose high deductible health planseven if it saves us thousands of dollars.
他们和他们的雇主为此付出了代价（勉强付出了很多代价），但目标是像对待汽车保险一样对待它 - 希望您和您的家人永远不必提出索赔。
This may be fine when it comes to driving carefully. But when it comes to health, sometimes illnesses or injuries impose themselves, regardless of precautions – and it can be stressful and financially devastating.
As health care costs continue to rise, the “car insurance” approach is commonly taken: to keep health insurance payments down, the one with the lowest premiums (i.e., the high-deductible option) is chosen.
There are a lot of reasons it’s a waste of time to do price comparison shopping in health care. The biggest, glaring problem is that billing is complex, perhaps not maliciously but certainly imprudently. Add to that what patients don’t know: different rates negotiated between insurance companies and physicians for everything from office visits to scans to surgeries.
So, if patients can’t shop for the best price for their procedures, choosing a high-deductible plan with a lower premium cost seems the safest bet. Too often, the apparent cost savings in terms of premiums are not savings at all, swapped for high costs for everything else — from office visits to medicine to procedure costs.
Regulators should push health savings accounts (HSA) and businesses should offer them. While HSAs are growing, they are still only available to30％的工人- 大公司比较小的公司更有可能。当然，这是一种帮助支付额外的医疗费用，几乎总是在高昂的可扣除健康计划下产生的方式。
Perhaps a better option is to require all health insurance plans come with free primary care office visits. That can encourage patients to seek care earlier at lower costs (especially when compared to hospital emergency rooms or urgent care facilities, sites of choice if patients wait). One compelling example of this is when plans build in access to direct primary care.
High deductible health plans are not going away, but we can guide our community better to make costs transparent for better decision making.
本·艾肯（Ben Aiken）is a family physician.