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


I have learned over the years that much of conservative politics and economic policy is driven by spite.


No. It’s not. At best, an applied math, but most economics is not at its best.

Also the error in your image is in the “Equate indices” step below
because the exponential function is periodic on complex numbers. So unlike when the arguments are real numbers, you can’t cancel the e. Or, in other words, while the exponential function is one-to-one on the real numbers, it is not so on the complex numbers.




A close relative by marriage was an economist of some note back in the late 1960s and 1970s. I remember paging through one of his books when I was young and commenting to him about all the complicated looking equations. He told me “yes, there’s a lot of math, but that doesn’t make economics a science.”

I’ve found that any economist who claims his discipline is a hard science is usually more interested in justifying the concentration of large amounts of wealth into the hands of a relatively small group of his political compatriots.


After years of study on the question, the best answer I could come up with for the Demarcation Problem is that “science is any field of study in which cumulative research produces a collective and continuing increase in accuracy of prediction, measurement and explanation”.

Some bits of economics may qualify for that. The discipline as a whole does not, so far.


I would not quite say “spite” . The right word is tough to pin down, but “ideology” is getting close.

The “idea” that there may be some parties which game the system in a way they find distasteful makes the whole system suspect, regardless of how often the reality is. In this case the idea that hypochondriacs may get catered to at everyone else’s expense. Welfare Queens come to mind as well.


Not if they can now actually get that mental health referral.

There is a causal link between artificial scarcity, and greed.


hey man, he has a very scientific gut. it’s full of stuff with latin names and everything!


But at the core is a type of spiteful selfishness.

It’s like the kid that throws a tantrum because they think another kid got a slightly larger slice of cake.


If you wanted to turn this article about exploitative copayments having caused negative incentive structures (which any decent economist can tell you about) into an appeal to anti intellectualism, you could at least cite a single mainstream economist that thinks these are a good idea.


Type in Effect of Copayments into Google and you’ll find a decent haul of shudder economics papers regarding their negative effects. But I guess no one believes in experts any more, so let’s write an article based on fluffy anecdotes from advocacy groups instead.


I do think there is some truth to that argument, but - as far I understood - the copays for many in the US healthcare system are just too plain crazy high.

And, as someone else wrote already, for copays to have any effect on overuse, they should be adjusted to income/wealth.


Great analysis, thanks a lot!

Although I would be careful with the last statement, AFAIK there is no conclusive evidence on the obesity epidemic, i.e., not all of it can be traced back to lack of exercise and too high calorie intake.


I don’t think the issue with screening programs is so clear-cut. There are really difficult trade-offs to be made when considering a screening program.

E.g., for breast cancer screening by mammography, the Cochrane (systematic) review puts the numbers as this:

for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.

Now, how do you value the one saved life against the massively lowered quality-of-life for the 10 overdiagnosed women (breast cancer treatment is no fun, I guess everyone can agree on that), not considering the stress for those with false-positive findings? I don’t know, this is really hard!

Furthermore, it is really hard to get those numbers (to base your trade-off on) more or less correct in the first place, so we’re not even quite sure on those either! Now, is it any surprising that opinions regarding mammograpy screeing are somewhat fluctuating?

[edit for correcting typos]


Arrow, Kenneth (1963). “Uncertainty and the Welfare Economics of Medical Care”. The American Economic Review. American Economic Association. 53 (5): 941–73. JSTOR 1812044

The latter is one of the most famous papers in micro economics. Its one of the reasons why Akerlof is probably the best American ecomomist ever.

Moral hazard is a very old concept in insurance. The problem was well understood in the Lloyds insurance markets of the 18th century.

I do not argue that co-pays have no effect on the consumption of medical services. That they do is the whole point. The question is whether consuming medical resources at the zero price point is more efficient for society than applying a non-zero cost.

Not that you had addressed your comment to anyone but I thought it a good point and worth addressing.


+1 for the link to the thread, I hadn’t stumbled upon it yet, will need to read up, thank you!

[edited for typo]


I shouldn’t be surprised that in the US buffets have rules should I?

I realise that this is a symptom, not a cause, but this is why you can’t have nice things.


Moral hazard is a thing wot exists, but that doesn’t make the economist a “court astrologer” for the rich and powerful. As your link suggests, Arrow lists reasons that might ameliorate the impact of moral hazard in the case of medical insurance, and he was writing in 1963.

Maybe you’re just agreeing with me here, but dodging the critical question of “how big a deal is moral hazard actually” and “what are the costs of co-payment relative to this” in favour of huffing and puffing about spiteful buffet gorgers is not great, at a time when mainstream economics should really be the left’s greatest allies.


This x 100. Extensive preventative screening is the equivalent of locating a fire station within a half mile of every single residence.

Good article with some good recommendations:


All very good points. You might want to look into how Medicare sets physician (over)payments and how it ripples through the whole system.

What, ME??? The VOTER???


Any ‘science’ which fails to account for the laws of physics is decidedly, well, not science.