Better Copays

To continue in the same vein of trying to find ways to decrease health care costs, I want to address another issue - copays. Copays are designed to share the cost of a doctor's visit or a drug prescription between the patient and the insurance company. This (slightly) helps a person think twice before going to the doctor over something trivial or having a prescription filled that they may not really need. Have you ever had a precautionary script given to you? Just in case you need it you can have it available to you. If it wasn't for the copay, you might just fill it and let it sit on your shelf for two years.

But the problem comes when it is time to shop around for your prescription. Who does this? Not me. I like my pharmacist, so I go to him. It costs me the same $10, $30, or $55 irregardless of who fills it - my favorite pharmacist or some other one down the street. I almost never know the actual cost of the medicine (what the insurance company pays). It might cost less at another pharmacist, but I don't know because I don't ask and I don't shop around. It's all the same to me - just the copay!

Now if my portion of the copay was tied to the actual cost of the drug, if I could save money because one pharmacist charged less for the medicine than another, then I would be very inclined to go to the cheaper pharmacist or ask for less expensive drugs. Simple market dynamics in action. So, instead of having fixed copays, I think we should pay fixed percentages of the cost of the medicine. Example: if my insurance plan had a 20% copay for drugs, then I would certainly shop around and buy the drugs at the store with the lowest price. I would even ask my doctor before he writes the script about options that cost less than the latest and greatest high dollar drug that he is probably getting a kick-back on.

Case in point - I can get my generic drugs at my local pharmacy for a simple $10 copay or I can go to Walmart (and now other places) to get a $4 generic. Guess what? I will endure the hassle of going to Walmart to save $6 per prescription! Why? Am I cheap? Maybe cost suddenly matters when it affects my wallet! I've even brought Walmart's list of $4 drugs to my doctor and asked him if there was anything on the list that would work for what was ailing me! It works!

Likewise, if a doctor's visit copay was a fixed percentage of the actual costs instead of a fixed dollar amount, then I would seriously consider my doctor's costs and shop around to see if his billing is reasonable. Right now, I never ask because it's all the same to me - either $20 or $40.

I really think that insurance companies with their current plan designs have done a disservice to health care costs because they have removed and isolated the patient (consumer) from the costs of their care. While at first this seems nice and comfortable, a great way to get health care at predictable prices for the consumer, it completely removes any initiative for saving money. Anywhere! The patient never makes a decision based on their actual cost of care. The insurance companies have fixed pricing contracts with providers and only pay what's in the contract. Since when has fixed pricing ever resulted in a free market or lower costs? Let the airlines be an example many years ago.

There must be a simple connection between the cost of services and the patient's/consumer's wallet.Then natural market forces would then begin working on the prices that doctors and companies charge and the services that patients request. It just might be a better way.