Dear Science

Do Co-Pays and Deductibles Actually Keep Heath Costs Down?


As someone with a chronic disease who must visit doctors frequently as well as take much medication I completely resent the co-pays. It is just another way to punish me for being unlucky enough to have a serious illness. It's not smart health wise at all! Co-pays on consumer goods, as in taxes, makes sense - taxes on health care make no sense at all. I honestly think MOST people go to doctors because it's a smart or necessary thing to do, not because they like to go.
In my humble opinion, co-pays and deductibles are just one more way for the wealthy to make sure that they don't have to share a waiting room with any dirty poor people, and to make doubly sure that they don't have to wait for their hangnail to be seen to while the doctor is wasting his time saving some impoverished person's life.
"...spending on preventative care saves vast sums of heath care dollars..."

Sorry but that's dead wrong. New England Journal of Medicine says otherwise. Many, many studies beside NEJM state that preventative care improves quality of life but the cost of testing procedures for those without the illness outpaces the cost of treating those who contract the illness.

So - preventative medicine: Good thing to do for your health but not the answer to reducing overall costs.
Oh, you poor poor people, imagine having to pay for goods and services! Leaving alone how botched and messed up our 'insurance' system is (huh, a for profit corporation instead of a not for profit organization, and you are surprised when they shaft you for an extra dollar?) for the moment, if people actually payed then the cost would go down. A sue happy enviroment coupled with lax mal practice laws make this horrendous, plus the hospitals having to pick up the tab when medicaid or medicare don't cover all of it.

@smart minded-- It makes sense to do it in bulk, rather than the personal scale. I know a women who works with insurance and companys to get things working, and the money saved on the one or two undiagnosed diabetics out of the group just grossly outweighs the testing costs.
@smart minded: I'll check out the research you're referring to, but I doubt your claim holds up in the context of sensible, routine medical care. Most annual check-ups don't involve any expensive testing. The only time they'd do expensive testing is if they have some reason to suspect it's necessary.

It's possible that medical practitioners sometimes charge a lot for routine checkups, to offset the cost of people who only come in with medical emergencies and can't pay. The cost of the checkups might be greater on paper, but that doesn't actually mean they're expensive to provide.
If it isn't worth $20 for you to see me (the doctor), I don't want you taking up space in my waiting room and my valuable clinical time. If you're not willing to pay $20 to see me, you're certainly not going to follow my advice.

Health Care is a service like any other. Do you expect your plumber or electrician or auto mechanic to serve you for free? No? Then don't expect your doctor to do it! No one owes you medical care. It is your body, and your life and therefore your responsibility.

There ain't no such thing as a free lunch!!!!
Jonothan Golob calls himself science but can't take the time to move past the emotional argument of "preventative care saves lives and money" on to the cold, hard, scientific truth that screening for diseases in everyone is more expensive than treating the few who are actually sick, at least in most cases.
If it's not worth my $20 to get health care, perhaps I can't afford $20. I have clients for whom that represents a substantial portion of their 'disposable' income.
Medicaid / Medicare? Don't make me laugh; no practitioners or waiting lists so long there's no point in signing up. Either they end up sicker and thus in hospital, or just gradually worsening til they can scrape up the $20.
...Or the doctor can't be bothered to really pay attention; 15-30 minutes late per appointment, wants to rush in, prescribe, rush out. And don't whine about paying off medical school bills; I see plenty of Dr's driving expensive cars; they're suffering in style.
It's not a surprise that all of my clients in extreme poverty have diabetes - and because they are getting substandard care they will have worse side effects. We will pay for their tests, their surgeries and ultimately their deaths because we are too cheap to pay for routine care.
Standard care today does not include expensive screenings as part of preventative medicine, so the argument that prevention is more expensive simply doesn't hold up. Now, one might argue that a single-payer system would change the standard practice because people would demand expensive screenings once the personal cost was eliminated. All that suggests, though, is that a viable single-payer system needs to be one in which people don't have the right to demand things the doctor says are unnecessary. And this makes perfect sense. We wouldn't let patients demand morphine, so why let them demand unnecessary screenings?
Right Zack. I'm sure your extensive background in Medicine provides a much more thorough analysis than the New England Jounal of Medicine.
Seeing as you have no idea what my background in medicine is, Smart Minded, you surely don't have the grounds to make such a comment. Then again, rhetorical comments like yours are rarely concerned with such petty things as facts.

But for those who are interested in an actual discussion, let's look at my comment and the NEMJ article (since he didn't specify, I will assume Smart Minded was referring to the oft-discussed analysis by Cohen et al.) side-by-side. My comment proposes using the current practices of standard care as a model and including some mechanism to prevent patients from demanding expensive and unnecessary screening procedures. The model of preventative care employed by the NEMJ article, on the other hand, assumes a more rigorous screening process than today's standard care provides. In other words, it assumes that we will start doing screenings that would be deemed unnecessary and excessive in the current system. As such, we should be rather unsurprised that the NEMJ model is more expensive. Insofar as that model is an accurate representation of what certain politicians were in favor of, the criticisms of Cohen et al. are quite relevant. But what they discuss in their article is not an accurate representation of my suggestion, and so the two discussions are incommensurable.

In short, the model of preventative care discussed in the NEMJ is problematic, but it is not the only model of preventative care out there. If we are to have a single-payer system, then, we would want it to be closer to the current (less expensive) standard care model. It is also to be noted that the graphs presented in the NEMJ article suggest that certain preventative measures are, in fact, cost-effective. We would want to be sure, then, that those were incorporated into the standard care model if they are not already part of it.

These comments, of course, are still not as thorough as one might like. But such is the nature of internet comment boards. Even if I were capable of writing an analysis like that found in the NEMJ, no one here would read it. And, indeed, it would be foolish of me to suspect anyone would. And so I present my thoughts in a shorter format for people to take or leave as they find appropriate.

(And for anyone who is wondering, my background in medicine is admittedly meager. My mother is a doctor and I myself worked in health care for six years. I am well aware of the preventative measures that are part of standard care, however, and they strike me as quite cost-effective and worthwhile.)