A commonplace of conservative health care policy thinking is to argue that the problem of high costs in the United States is driven by the fact that U.S. health care consumers don’t have enough “skin in the game.” How this explains why our costs are higher than those in other western democracies where consumers have even less skin the game is a bit mysterious to me. But Austin Frakt observes that whether or not shifting people into high-deductible plans is wise, it’s happening to a much greater extent than this pat debate tends to acknowledge:
My guess is that to the extent that extra skin in the game induces consumers to reduce consumption of health care services, they’re going to prove to be very poor judges of what treatments it does and does not make sense to forego. Consequently, for every patient who ends up utilizing health care resources in a more cost-effective way, we’ll see another patient who ends up with avoidable health problems and ends up needing more services than ever. But time will tell, since this trend clearly isn’t going to turn around in the next few years.