Stories

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

A hospital sign with the 'H' replaced with a dollar sign
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