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Letters to the Editor
May 14, 2004

Medical co-pays shouldn’t be increased
To the editor:
Today (May 10) I received a survey from my PAT councilor. Medical co-pays are “projected to be adjusted for Jan. 2005” and the university system is trying to contain its part of the costs – by passing them on to employees as co-pays they don’t have to share the burden of. Here are my thoughts.

Extra fees should be charged to affect people’s behavior – never with the primary intent to cover cost increases or to generate revenue. Managed care was supposed to reduce costs with a combination of carrots and sticks. It was supposed to channel people to the appropriate level of care without bankrupting them.

It would be one thing to increase co-pays for specialists and emergency room visits, although if this care is needed and prescribed the patient should not be penalized. Perhaps this increase is intended to affect how primary care physicians behave, rather than patients?

But the co-pay for primary care should be low or nothing. Regular physicals and preventive care, we were told, are the keys to cost-effective care delivery. To raise this co-pay is way too much of a stick – what has happened to the carrots?

Increasing the co-pay for prescription drugs is just caving in to the pharmaceutical companies. Let them take the co-pays from drug companies’ ballooning profits.

And adding co-pays for hospitalization is adding real injury to insult. Are there really people out there abusing this? If so, this is probably not the best mechanism to identify and deal with them. Most people (and their families) are debilitated and traumatized by a hospitalization and would not welcome additional stress. Again, if this care is prescribed by the physician, it is presumably necessary.
Rather than continuing to increase costs at the receiving end, at the point of care, medical coverage should be structured to capture revenue at the front end. Then we will all know just how bankrupt the health care delivery system is in this country.

In the short term I would recommend reducing or eliminating co-pays altogether and getting insurers to quote for full coverage. The whole idea of insurance is to spread the risk across the widest group and not to nickel and dime – excuse me, $50 and $100 – the supposed beneficiary of the coverage. As it is now, and it is rapidly getting worse, an unfortunate few are hit with a disproportionate amount of the cost as co-pays if they have extensive medical needs. And the university system saves money (or avoids even worse cost increases) because, in effect, the value of the benefit is reduced for all.

In the long term, of course, a single-payer, not-for-profit health care system is necessary. I don’t think it’s an exaggeration to call the current situation a crisis. Employment decisions are increasingly distorted by a failed “fringe benefit” whereby employees and employers decide to work or not, to hire or not, to RIF people and to outsource their jobs, based on the exploding cost of health coverage.

Don Gordon, business manager, UHS


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