There is also the hidden benefit of being insulated by their employer, who absorbs any rise in health care cost. Provider panels, overages, family structure complexities, and other information requirements that factor in to health insurance decisions can be overwhelming, and the implications potentially more threatening. A decision that affects a stock portfolio doesn't carry the same weight as one that affects health. I am not finding my clients wanting it. I'm not finding my client's employees wanting it.
Adverse selection is another obstacle in the defined contribution model.
The whole concept of risk and group identity structure will challenge traditional underwriting approaches. Without employers filling the role of risk pool, a balance of sick and healthy people that allow plans viability may be threatened. In addition, small employers have never had the leverage in negotiating managed care contracts that large employers have had. There may prove to be a major advantage by way of improved relations between patients and providers. In the long term, a consumer-centric model may force providers into enhancing customer service, such as having more direct contact with patients, which would be a considerable change for the better, considering the poor interaction between the two today.