It isn’t hard to think that conservatives’ newfound concern over high deductibles has more to do with their views on Obamacare than anything else. But what matters is that concern is justified. High-deductible plans were never a very good idea.
Let’s start with RAND’s Health Insurance Experiment. That study didn’t just find that people respond to higher costs; it also showed that they sometimes respond by making bad decisions. The explanation isn’t a mystery: People who don’t have medical training can be terrible discriminators between necessary and unnecessary care. For example, poor people who had hypertension in the study had higher mortality rates, strongly suggesting that they were less likely to seek necessary care.
There’s plenty of good evidence that increased cost-sharing such as that seen in high-deductible health plans can lead to negative consequences for some patients. My own experience as a physician backs that up. I often find that patients have a difficult time getting the care they need. Research shows that moral hazard could be helpful, if it encourages people who might otherwise not obtain needed care to do so. Trying to reduce it with increased cost-sharing might actually do harm.
It’s surprising to see those who have long disagreed with me suddenly reverse course and “fear” high deductibles. Well, better late than never. Increased cost-sharing depends on a belief that consumers are using too much health care, and that we need to find ways to induce them to spend less. But we also need to find ways to make sure people aren’t skipping needed care because of cost. That seems like something liberals and conservatives finally agree on.