Medical Tuesday Blog

High Deductible Insurance with Copays Increase Health Costs

Sep 17

Written by: Del Meyer
09/17/2019 3:40 AM 

Medical Myths & Rumors

There are several factors in healthcare insurance that are confusing people. Some insurance carriers are advertising low cost policies with no deductibles or no copayments. This, however, results in an increase utilization which will increase the cost of healthcare. The insurance company in turn then acts as the “palace guard” by denying benefits. People have gotten used to being denied by the insurance companies for coverage of a test or procedure. With more frequent ‘denials” seen on their printouts, they have accepted the carrier’s superiority to their physicians judgements. This, in the absence of medical judgement based on medical history and physical examination, would in essence decrease quality of care (QOC). It may also increase the cost of care.

The amount of the deductible should be correlated with the average cost of routine care. Routine cost of care goes up as we age. This can be determined with algorithms based on age for each decade of life. For instance, a deductible of $200 per year may suffice for a person in his 20s who maybe would need an office visit, a CBC, UA, and a baseline screening panel.

A person in his 30s would also need an office visit, baseline screenings of abnormal tests previously determined. He may also require a chest x-ray. A deductible of $300 per year during his 30s should be sufficient to cover the cost of care in his 30s.

A person in his 40s would need an office visit, follow up screenings as needed. He may need an ECG. Hence, a deductible of $400 per year should cover the costs of his care during this decade of life.

A person in his 50s may need other tests and a deductible of $500 per year should cover the cost of routine care during this decade of life.

By projecting baseline routine cost of care in his 60s to a $600 per year deductible, in his 70s to a $700 per year deductible, the cost of routine care is certainly manageable by the vast majority of Americans.

If this routine care were covered by insurance, it would cost at least twice as much and this would be seen in an insurance premium of more than twice the cost of care than if paid directly.

But what if we need an operation, delivery, or hospitalization for a heart attack? This could be covered by a major hospital/surgery/obstetric insurance policy. These policies would then become affordable because they do not have to cover the exorbitant cost of routine care, which has only become exorbitant because of third party or insured care. With everyone paying directly for his primary care, the cost would easily be cut in half since each individual will determine his own medical needs and not a third party who has minimal knowledge of his medical state.

Thus all healthcare costs would become affordable without any government intervention. This would deprive politicians from out bidding each other on what healthcare benefits would cost. They could then speak to the real issues of foreign policy, international affairs, defense, veteran policies, and other domestic affairs.

Care of the underprivileged, poor and VA care are already present and only need some mild to moderate reform.

Thus health care costs would be totally outside of any government control, become efficient and economical.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

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Categories: Medical Myths

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