I recently saw a patient complaining of shortness of breath and a persistent cough. Worried he was developing pneumonia, I ordered a chest X-ray. He refused. He hadn’t met his $3,000 deductible yet, and so his insurance would have required him to pay much or all of the cost for that scan.
He chose to gamble on a cough, and five days later, he lost — ending up in the ICU with pneumonia. He survived, but the cost of his “savings” was a nearly fatal hospital stay and a bill that will quite likely bankrupt him.
As a physician associate in primary care, I serve as a frontline witness to this failure of the American approach to insurance. Medical professionals are taught that the barrier to health is biology: bacteria, viruses, genetics.
But increasingly, the barrier is policies that pressure insured Americans to gamble with their lives. High-deductible health plans seem affordable because their monthly premiums are lower, but they discourage patients from seeking and accepting diagnostics and treatments — sometimes turning minor, treatable issues into expensive, life-threatening emergencies.
The economic theory underpinning these high deductibles is known as “skin in the game.” The idea is, if patients are responsible for the first few thousand dollars of their care, they will become savvy consumers, shopping around for the best value and driving down costs.