There are two legitimate reasons for health insurance copayments (that is, you pay for part of a treatment or drug). The first is that copayments provide ownership: by requiring a nominal payment for those who are not indigent, it reinforces that idea that this isn’t charity, but a common social obligation, on the part of those who provide and those who receive healthcare. In other words, those who use a lot of services should provide some additional support to the system. The second legitimate reason is that it discourages frivolous use. If you have a toothache, you probably shouldn’t go straight to the MRI. Perhaps a dentist should poke at it first.
And then there’s insulin.
A couple of days ago, I was talking to a reader (hereafter “Dear Reader” or DR) about healthcare. DR is a juvenile diabetic and requires insulin (juvenile diabetes is an autoimmune disease and onset is not related to poor diet). DR mentioned to me that DR spends $100 per month on the copayment for insulin; it’s a fifty dollar copayment for every refill at the pharmacy. As far as we can determine, the insurance is only picking up about one-third of the cost.
DR is fortunate, in that the $1200 per year isn’t prohibitively expensive; DR is also fortunate in that DR’s daily usage of insulin is a lot lower than many juvenile diabetics (by about a half to two-thirds). Keep in mind this is only the cost of the insulin–we haven’t even talked about the cost of blood sugar monitoring or needles. How could a family around the U.S. median income (~$50,000 in 2008) could afford a $1,200 copayment (or even more) in conjuction with these other costs? I suppose cutting out eating is one option.
Which brings us back to the rationale for copayments. No one takes too much insulin because they feel like it (that actually could lead to brain damage if not dealt with). There’s no potential for waste involved here. Quite simply, a juvenile diabetic must have the insulin he or she needs to treat this chronic condition. If he or she takes too little, they get sick and eventually have to be hospitalized (which is expensive).
Yet, in the case of insulin, the copayment is large, and for people of modest means who are not poor, it is too much. It’s safe to assume that this is an attempt to gouge people who have no alternative.