The basis for the health-insurance copay is that the 99% need to be disincentivized from "abusing" their health-care and going to the doctor for frivolous ailments (if this was really a thing, we'd have sliding-scale copays that charged rich people astounding sums to see the doctor, to ensure that everyone's incentives were properly aligned).
The reality is that copays are a way to disincentivize people — especially poor people — from getting necessary treatment, a way to shift the cost of healthcare from insurance companies and their shareholders to insurance customers and the taxpayer (when people who can't afford routine care end up indigent and hospitalized).
The fantasy of homo economicus whose incentives need to be paternalistically tweaked by cooly rational economist technocrats is used to justify shifting an ever-increasing proportion of healthcare away from insurers — whose incentives are a lot less murky than their customers, as profit-maximizing entities who save money every time you skip a doctor's visit — and onto customers.
Just another reminder that economics is often just an exercise in using shitty math to prove that being a selfish asshole is Pareto-optimal.
Once state Medicaid programs began charging copays in the 1970s, the new fees were associated with patients dropping out of health care plans. In some cases, there was a demonstrable impact on health: in 1975, California's MediCal program reduced doctors' visits with copays, only to have those savings offset by higher hospitalization rates.
Meanwhile, cost-sharing arrangements have continued in the private insurance market, shifting responsibility for systemic dysfunction onto individuals — as if soaring health care costs are caused by patients unnecessarily demanding CAT scans and blood tests like a spiteful customer at the Old Country Buffet piling their plate high in an effort to make the restaurant take a loss.
The burden of high-deductibles and copays continues to spawn new profit centers for the industry that imposed them: private Medigap insurance offsets costs not covered by Medicare, and Health Savings Accounts siphon off the public tax base to help holders save cash to cover costs like high deductibles. Insurance regulations, like those introduced by the Affordable Care Act, have left companies once again searching for savings through cost-sharing: in 2016, over 39 percent of Americans from ages eighteen to sixty-four held high-deductible health plans, up from 26 percent in 2011. In the past decade, cost-sharing payments have risen at more than twice the rate of wages.
Down With the Copay
(Image: Claus Ableiter, CC-BY-SA)
(via Naked Capitalism)