Opinions expressed by Forbes Contributors are their own.is a study in contrast. On one hand it is a chatty, easily accessible look at the failings of the US health insurance system by two of the nation’s best young health economists. But behind the one-liners and informal presentation, it proposes a highly provocative, radical alternative to our current mess.
Here is their logic: While significant cost sharing lowers overall health costs, it also sticks low-income patients with big medical bills they cannot afford, which defeats the purpose of universal access. On the other hand, very modest cost sharing might be manageable for most but wouldn’t reduce overall costs very much. And some of the very poorest still might not afford care, which again is counter to the idea of universal access.
For example, hospitals are required by federal law to treat anyone who walks in the door. Then we leave it to the hospitals to bill the uninsured, who can’t pay. Another example: There is no insurance for many people at high risk for diabetes. Thus, they put off care and get sicker. But once they go into full-blown kidney failure, Medicare pays for everything, including expensive transplants.
Einav and Finkelstein correctly anticipated that some critics would complain that their idea would create a two-tiered health system. Those who could afford supplemental coverage would get better care than those who have only basic insurance.
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