During my active practice days I was called to the emergency room to see patients that had arrived by ambulance. Finding a simple problem such as a sore throat or a cold, I wondered why they took such an expensive ride to a very high cost center when their problem could have been taken care of in the office that day or the next.

The answers vary: I couldn’t get a ride during the day or I work during the day or I couldn’t get a baby sitter until my husband got home. Others stated that if I came by car, I have to wait 3 or 4 hours to be seen. If I come by ambulance, I’m ushered right in and triaged and frequently seen at the same time.

One item is usually the same. They do not have to pay to be seen. The average base ER charge in one of my hospitals was $600. On one study we did, we asked the question, “If you had to pay 20 % ($120) would you have come in?” The answer in our clinical overview was that four out of five invariably said “no.” I would have come in during the day today or tomorrow. Thus a 20% copayment at the registration desk would have saved 80% of the non-urgent healthcare costs.

Thus, free or non-deductible healthcare increases healthcare expenses by four fold.

The same effect can be found on all non-emergency health care. A study by the Council for Affordable Health Insurance (CAHI) suggests that perhaps a third of medical spending is devoted to services that don’t appear to improve health or the quality of care—and may even make things worse.

Our clinical overview suggests that it may be as high as a half of health care spending is gluttonous.

Thus the only way to eliminate this gluttony is with high deductible and graduated copayments where the deductible is the average cost of basic health care for that age group and copayments graduated on the basis of where that care is obtained. Out study indicates the optimal copayment would be 10% for hospital care, 20% for ER and Urgent care, 30% for office and outpatient care, and approximately 40% for DME and Skilled nursing care. Without any actuarial data, it is estimated that one would save twice the out-pocket deductible and copayments in the price of that type of insurance.

The insurance companies would then have to realize that their profits may decrease, but won’t go to zero as they did in Vermont and now in Colorado.

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.