Exposed : Why Our Health Insurance Is Incomplete and What Can Be Done About It

Democrats and Republicans fight endlessly over health care, but neither side disputes one of the system’s most basic flaws: the foisting on patients of substantial costs through deductibles, copayments, and coinsurance. Marshalling a decade of research, Christopher Robertson shows why this model is dysfunctional and offers ideas for improvement. A sharp exposé of the roots of the cost-exposure consensus in American health care that shows how the next wave of reform can secure real access and efficiency. The toxic battle over how to reshape American health care has overshadowed the underlying bipartisan agreement that health insurance coverage should be incomplete. Both Democrats and Republicans expect patients to bear a substantial portion of health care costs through deductibles, copayments, and coinsurance. In theory this strategy empowers patients to make cost-benefit tradeoffs, encourages thrift and efficiency in a system rife with waste, and defends against the moral hazard that can arise from insurance. But in fact, as Christopher T. Robertson reveals, this cost-exposure consensus keeps people from valuable care, causes widespread anxiety, and drives many patients and their families into bankruptcy and foreclosure. Marshalling a decade of research, Exposed offers an alternative framework that takes us back to the core purpose of insurance: pooling resources to provide individuals access to care that would otherwise be unaffordable. Robertson shows how the cost-exposure consensus has changed the meaning and experience of health care and exchanged one form of moral hazard for another. He also provides avenues of reform. If cost exposure remains a primary strategy, physicians, hospitals, and other providers must be held legally responsible for communicating those costs to patients, and insurance companies should scale cost exposure to individuals' ability to pay. New and more promising models are on the horizon, if only we would let go our misguided embrace of incomplete insurance. "In Exposed, Christopher Robertson looks at a widely-shared point of agreement in the political battle over how to reshape U.S. healthcare: Nearly all sides believe that health insurance coverage should be incomplete. Driven by a particular economic theory of valuation, the law now reflects this consensus that patients should bear a substantial part of the costs of their own healthcare. In theory, this strategy empowers patients to make cost-benefit tradeoffs as they decide which healthcare to consume, and it could thereby be a force for efficiency in a healthcare system that is rife with waste. But, in fact, this approach to financing healthcare can erode the very purposes of insurance, as it keeps people from valuable care and drives patients into bankruptcy. Contrary to the traditional economic theory of "moral hazard," Robertson identifies the real problems driving wasteful healthcare spending as a lack of good scientific evidence about what healthcare works. Exposed develops an alternative economic framework to understand the real purpose of insurance, pooling resources to provide access to care that would otherwise be unaffordable to individuals"-- Provided by publisher