The copay assumes the 99% treat healthcare like spiteful buffet gorgers

[doctorow]

Originally published at: https://boingboing.net/2017/10/08/corporate-incentives-matter.html

…

[Nobby_Stiles]

@doctorow

The fantasy of homo economicus whose incentives need to be paternalistically tweaked by cooly rational economist technocrats is used to justify shifting an ever-increasing proportion of healthcare away from insurers – whose incentives are a lot less murky than their customers, as profit-maximizing entities who save money every time you skip a doctor’s visit – and onto customers.

You know, of all the terrible features of US health care, the co-pay doesnt make it into my top 5 worst features. And yes, co-pays do treat consumers like greedy buffet goers. The problem is that greedy buffet users do exist - thats why buffets have rules. Your average hypochondriac probably is a little wasteful in their use of healthcare resources.

I would list them in order as something like

Top 5 worst features.

a) The uninsured.
b) Prior condition exclusion
c) Lifetime limits
d) Restrictive networks
e) Employment linking

But thats just me. In my world some people are just a-holes.
And I do like the idea of sliding co-pay scales!

[gracchus]

Just another reminder that economics is often just an exercise in using shitty math to prove that being a selfish asshole is Pareto-optimal.

It only seems that way because neoliberalism has been turned into the need-not-speak-its-name default by Libertarians and other greedy guts who go through life projecting their own crappy and selfish inclinations on everyone else.

[Mister44]

Shit I would LOVE a co-pay option. My plan sucks so hard I just try to pay cash when I need to.

[lloydcogliandro]

Is this a personal plan or employer provided? If it’s from your employer then either they are looking for an excuse to screw their employees over or don’t realize that it’s just taking money and providing no benefit.

[anon76197405]

So, even with the article explicitly stating your specific argument is fantasy and giving evidence why, you’re just gonna go ahead and regurgitate it?

@Nobby_Stiles

Your average hypochondriac probably is a little wasteful in their use of healthcare resources.

I’d think people who avoided preventative treatment and end up needing costly hospital stays are lot more of a burden than somebody endlessly asking for blood tests.

[lloydcogliandro]

@Nobby_Stiles

And yes, co-pays do treat consumers like greedy buffet goers. The problem is that greedy buffet users do exist - thats why buffets have rules.

The problem isn’t that there are rules. The problem is the typical Neoliberal application of “moral hazards” where boob-jobs for the teenage daughters of the rich or boner pills for 80 year old billionaires are perfectly justifiable, but a manual laborer trying to get pain meds for a sore back have to prove they aren’t addicts or just being lazy and looking for a handout.

[Nobby_Stiles]

@jeezers

So, with even the article explicitly stating your specific argument is fantasy and giving evidence why, you’re just go ahead and regurgitate a failed argument?

So you dont go to buffets much do you?

I read the article and it said that

@doctorow

reality is that copays are a way to disincentivize people – especially poor people – from getting necessary treatment, a way to shift the cost of healthcare from insurance companies and their shareholders to insurance customers and the taxpayer (when people who can’t afford routine care end up indigent and hospitalized).

If only I could use the word “reality” and use that to prove my argument. There are issues of rising health care costs in the UK and Canada. The US is a crap example to use because it has a crap health care system. And it wasn’t that I disagreed with the point about co-pays. Its more that I didn’t think co-pays were the biggest problem in the system. For anyone who isn’t insured it aint.

So to paraphrase your argument style, even though I explicitly stated that in my comment you went right on ahead and made your point anyway.

[anon73430903]

@Nobby_Stiles

I read the article

This article linked at the bottom of Corys one?

Down With the Copay

@Nobby_Stiles

There are issues of rising health care costs in the UK and Canada.

The UK’s problems are because of decades of underfunding. The 0.1% need their tax cuts more than they need a healthy workforce apparently.

[Nobby_Stiles]

@lloydcogliandro

The problem isn’t that there are rules. The problem is the typical Neoliberal application of “moral hazards” where boob-jobs for the teenage daughters of the rich or boner pills for 80 year old billionaires are perfectly justifiable, but a manual laborer trying to get pain meds for a sore back have to prove they aren’t addicts or just being lazy and looking for a handout.

I agree. Its a stupid system. I think its a disgrace. Thats why I supported Sanders. But co-pays exist in this system regardless of whether you get the script or not.

As a total aside, I have recently had a lot of interaction with junkies. Im a little bored of them. They are giant sized fucking a-holes and a danger to everyone who interacts with them. Even the above 50-year old ones.

I have also had a lot of interaction (of late) with non addict, ageing manual laborers in pain. 95% do their best to stay away from certain pain meds cos they can see what they do to people. Me personally, I would use Oxy if I needed it (and have). But some people take a different view.

[Mister44]

An employer plan. I do get some free visits per year, and the dental helped get my gum issues under control. But I have to see a pain doc every Month (thanks WoD) and it is cheaper to pay cash. The insurance is for when something bad happens.

That reminds me i think it includes glasses and should get some.

[Nobby_Stiles]

Sigh. Nope - I will read it now and then comment. But I do think co-pays are not going to be top of my list of necessary reforms to the system. Insuring the uninsured is.

[Footface]

And here I thought co-pays were just another technique for extracting even more money from us chumps.

[ChaksQ]

For profit healthcare doesn’t work. It’s focus is on profits, not providing healthcare. Well, actually, it does work in the sense it provides profits very well.

We need to ask ourselves if we prioritize the overall health of our society, or the profits of the healthcare executives?

[Nobby_Stiles]

@anon73430903

There are issues of rising health care costs in the UK and Canada.

The UK’s problems are because of decades of underfunding. The 0.1% need their tax cuts more than they need a healthy workforce apparently.

K read the piece. I thought it was good.

The UKs problems are partly about funding. But also partly about ageing. Old people go to the doctors a lot. Its not surprising, cos everything hurts, and because there is no real cure for their ills. If you go to the GPs in the UK you will see lots of old people waiting. One of the questions that exists in the UK is how to persuade people that actually the problem you have is not fixable and you will just have to suck it up and suffer.

Of course there are also people who have fixable problems. But there are lots of people who are in pain, and have real problems but they cannot be fixed.

One way of looking at this problem is to say that we as a society commit to allocate more of our resources to these people. I am in favor of that. But some people would argue that there are limits to this in an ageing population environment. In which case you will need some mechanism to provide some gentle disincentive to going to the doctors.

And mind who you call a neo-liberal. I’ve been a marxist since 1985.

[some_guy]

All I know is, I have watched my copay rise from $5 in the early 90’s to $30 today. Plus my doctor is right downtown in the city, so I typically have to use a parking garage that costs me another $10 unless I can get in and out in under 1/2 hour, which rarely happens.

[anon89609066]

@Nobby_Stiles

a) The uninsured.
b) Prior condition exclusion
c) Lifetime limits
d) Restrictive networks
e) Employment linking

My list is
a) red tape
b) more fucking red tape
c) being treated like I’m the problem when I’m not
d, e, f, g, h) then the rest of the stuff you listed

[anon76197405]

@Nobby_Stiles

Sigh. Nope - I will read it now and then comment. But I do think co-pays are not going to be top of my list of necessary reforms to the system. Insuring the uninsured is.

Amazing and perfect example of why this continues to be an uphill fight, people voting against their own interests because of a “gut feeling” based on complete and utter ignorance.

[anon76197405]

@Nobby_Stiles

As a total aside, I have recently had a lot of interaction with junkies. Im a little bored of them. They are giant sized fucking a-holes and a danger to everyone who interacts with them. Even the above 50-year old ones.

I have also had a lot of interaction (of late) with non addict, ageing manual laborers in pain. 95% do their best to stay away from certain pain meds cos they can see what they do to people.

Hey, just throwing this out here, you maybe think that these two things are related?

Also, you’re a really shitty marxist.

[wait_really]

@Nobby_Stiles

The problem is that greedy buffet users do exist - thats why buffets have rules.

One of the great joys of touring in a shitty punk band is eating at buffets (hands down casino buffets are the best don’t sleep on that!)

So yeah, there’s rules at buffets. And they are all easy to circumvent. I called it re-mealing- where you stick around so long you get hungry again, effectively getting two to three meals for the price of one. (Also, Chipotle does not give free burritos to touring musicians anymore, bastards…)