to the Editor
May 14, 2004
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