Sep 27, 2019

The "skin in the game" theory of health care hasn't panned out

Illustration: Lazaro Gamio/Axios

The theory that putting patients on the hook for more of their health care costs would make them better consumers — thus driving down overall costs — hasn't panned out, the LA Times' Noam Levey writes in his latest piece in a series on deductibles.

Why it matters: Health care prices are still rising, and are largely untethered to quality. At the same time, care has become increasingly unaffordable for many Americans.

  • This, in turn, has driven today's political debates over drug prices, surprise medical bills and overall costs.

Between the lines: High deductibles hasn't led to the kind of shopping that would be necessary for the "skin in the game" theory to be successful.

  • That's because shopping is often impossible, either because the service isn't planned in advance or because providers and insurers don't always make prices available ahead of time.

What they're saying: "We overestimated the ability of consumers to be good stewards of their healthcare dollars in a system that is very unfriendly to consumers, and underestimated the support they would need from us," Marcus Thygeson, a former Blue Shield of California executive who worked on early efforts to develop "consumer-directed health plans," told the LAT.

My thought bubble: We've pointed it out before, but there's a strong irony to the fact that conservatives' darling policy idea has led to Americans being more willing than ever before to accept a single-payer health plan.

Go deeper: "Skin in the game" doesn't work

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Four health care questions for a better Democratic debate

Photo: Win McNamee/Getty Images

If tonight’s Democratic debate is anything like the earlier ones, it will feature an extended back-and-forth about whether to eliminate private health insurance, and then move on from health care. But there’s a whole lot more that’s also worth asking about.

The big picture: We basically know what the candidates will say about the question of private insurance, because they’ve said it all before. So here are four other questions that might also help illuminate the choice voters face on such a deeply personal, wildly complex topic.

Go deeperArrowOct 15, 2019

The state of play in Germany's health care system

Photo: Bernd Wüstneck/picture alliance/Getty Images

In Germany's health care system, even universal coverage paired with low out-of-pocket costs hasn't led to equitable health outcomes among rich and poor people, NPR reports with Kaiser Health News.

Why it matters: Medical care is only one component of a person's health. Social determinants of health are hugely important and factor strongly into a population's well-being. "Universal health care, in and of itself, may be a first step toward increasing a community's health, but it isn't a magical solution," writes KHN's Shefali Luthra.

Go deeper: What the U.S. can learn from Germany on drug prices

Keep ReadingArrowOct 17, 2019

Health benefits won't change for GM workers

UAW workers have demanded health care costs stay the same. Photo: Jeff Kowalsky/AFP via Getty Images

The tentative deal between General Motors and the United Auto Workers includes an agreement to keep the same health care plans "with no additional costs to members," according to a summary of the deal.

Why it matters: Most employer health plans are getting more expensive and less comprehensive. The UAW is ensuring GM's benefits stay comprehensive for workers — a move that competing automakers Ford and Fiat Chrysler likely will adopt in their negotiations — but the coverage itself remains pricey and chips away at funds that could go toward wages.

Go deeperArrowOct 18, 2019