Chickens. Roost.

[OldDog]

WASHINGTON — For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

http://www.nytimes.com/2015/01/06/us...ulty.html?_r=1

[GenuineRisk]

That was an interesting article. And it highlighted (though not as much as it could have, maybe) the crux of the issue with having people pay a higher share of the out-of-pocket costs upfront- does it encourage people not to go to the doctor unnecessarily, or does it cause them to put off seeing a doctor about minor problems until they become major (and more expensive to treat)?

[OldDog]

A reasonable question. The answer is: yes.

[GenuineRisk]

Originally Posted by OldDog

A reasonable question. The answer is: yes.

Coincidentally, the front page blogger at Balloon-juice who works in the health insurance industry and regularly posts about the ACA, just put up a post addressing this. Great read, highly recommend, but here's where exactly this is mentioned:

"The traditional insurance model of deductible, co-pays and co-insurance is not a good model for chronically ill patients at any income level.


The theory behind these three types of out of pocket payments are to discourage people from consuming unneeded care. That works fine when the person is like my wife, in generally good health, and is debating on going to her primary care physician or sending me to the over the counter drug aisle at the supermarket to address a nasty head cold. That is marginal care, and it is voluntary care. Right now, over the counter drugs and lots of tea seem to be working but if it lasts another couple of days, the decision could change.

However someone with a chronic condition should always be getting their regular, preventative maitenance care without barriers as that type of care minimizes the number of truly acute high cost incidences from a broad society paying perspective as well as greatly improving the individuals counterfactual quality of life. A year of dialysis costs Medicare roughly $90,000 (depending on what county it is performed in etc), while regular care, medication and nutritional counseling for a diabetic costs the insurer $3,000. It is a massive net win for society for someone to stay in the bucket of managed diabetic rather than unmanaged diabetic with kidney failure. Some people may move from the managed diabetic bucket to the unmanaged bucket, but it should never be for the deterrant effect of a $25 co-pay or a $1,500 deductible preventing people from getting the routine, low level and far cheaper care."

http://www.balloon-juice.com/2015/01...n/#more-163928

Within the whole post (really, it's worth the time to read) is a link to another article about a guy with diabetes who, due to his financial circumstance, didn't qualify for ACA subsidies and couldn't afford regular insurance (because private insurers don't want to insure diabetics). So he did the best he could without, and now he's in end stage renal disease and Medicaid is paying for very expensive treatment, costing far more than regular treatment of his earlier stage diabetes would have.

[dellinger63]

Lord help us!

Some have become so entitled, dependent and programmed they can actually argue, with a straight face, that Harvard professors may be dissuaded from pursuing preventative health-care because of out of pocket expenses (co-pays and deductibles).

The average Harvard professor makes $198,400.

I see the light, a $1,500 deductible and $20 co-pay per visit is way out of line.