Tag Archives: policy

Intended Unintended Consequences of Co-Pays

Healthcare Prescription

Co-pays work really well for the chronically well and the chronically well off. Averaging about $40 for a doctor visit or outpatient procedure, $20-$40 for prescriptions and a little more for hospital admission. Might not sound like much every now and then. Insurance companies do this to prevent what they call a “moral hazzard.” I don’t know about you, but I’m convinced that my healthy friends would spend as much time as possible in a doctor’s waiting room if were not for co-pays. Great way to catch up on your reading from, say, 4 years ago. Plus, everyone loves a good colonoscopy and what woman wouldn’t prefer an extra mammogram or two a year? Surely, the typical mother of three who makes minimum wages has no problem working 20 or so extra hours to get her kids an annual check up. Great idea. This is America, for god’s sake. Pay to play. There’s no free lunch here.

It even works great for the fully employed and chronically not as well. Seeing a doctor a couple of times a year to get a script so you can get your Lipitor is just the price of being able to eat at McDonald’s or have a little Häagen-Dazs. No big deal. But what happens as you age? Say you add high triglycerides to your cholesterol, maybe it leads to diabetes. Your blood pressure shoots up. You fall down the stairs and injure your back. You find a lump or aren’t preforming as well in bed. Your snoring gets worse and fear sleep apnea while your partner can’t sleep at all for fear of your snoring. You get depressed about it and need something to mellow you out before you are tossed out at work. Your bowels stop moving, but your bladder can’t stop. Then, you get the flu. Pick any four and multiple by $40 for the visit and $40 for your drugs. Now $320 a month isn’t so bad until you do it for a year and realize you’re out almost four grand. Then your spouse hits for the cycle and it’s now eight grand, plus the deductibles, plus the cost of the policy. But that’s just for maintenance.

Once every decade or so in middle age, odds are you’ll have something that will put you in the hospital. God forbid if you are self-employed or part time. Miss some work. Lose some paychecks. Do some caregiving for your spouse and your world will begin to unravel. Visa will find out and raise your rates to 33% while lowering your credit limit. Now you’ll have to choose: do I see a doctor and get my meds or pay Visa? Do I buy my kids new shoes or play Russian roulette with my heart? Do I pay my life insurance or risk dying? Or better yet, do I pay my health insurance and join the 47 million who don’t have it or use it one last time? Decisions. Decisions. Decisions.

  • AP says “the ailing economy is leading many Americans to skip doctor visits, skimp on their medicine, and put off mammograms, Pap smears and other tests, a trend that physicians worry will result in sicker patients who need more expensive treatment later.” The Kaiser Family Foundation found that 36% of U.S. residents have delayed medical care in the past year because of cost. AARP reports, “Nearly half of Americans now report that someone in their family has cut back on their medical care or prescribed medications—postponing checkups, recommended tests and procedures; cutting pills or skipping doses of required medications; or not filling new prescriptions.”
  • The National Coalition on Healthcare says, “Retiring elderly couples will need $250,000 in savings just to pay for the most basic medical coverage. Many experts believe that this figure is conservative and that $300,000 may be a more realistic number.” Of course, there’s always Medicaid once you and your family are destitute.
  • This is pretty odd when you consider what that a study by GlaxoSmithKline (big pharma) says, “High prescription drug co-payments are associated with lower medication adherence and higher total healthcare costs.”

It seems almost silly to say that this can’t be healthy for our nation. It’s cruel, immoral and un-all-faiths, but is how we age in America. Well done insurance industry lobbyists. Well done. Makes us all proud.

Let me leave you with something from TomPaine.com, “Right here in the U.S., Medicare demonstrates that we can eliminate some 17 percent in administrative expenses alone through a publicly administered system.” I know. I know. I know that universal care is a dead issue in the US and that statistics aren’t reliable unless they are on Fox News, but isn’t pretty to think that some of that 17% (works out to about $250 billion) could reduce co-pays?