The Spectacle Blog

Co-Pays versus Coinsurance

By on 12.5.09 | 8:36AM

Hoo, boy. Every day brings more surprises. Reading the House bill I came across a peculiar provision I haven’t seen mentioned anywhere. As part of Title II, Subtitle C, “Standards Guaranteeing Access to Essential Benefits” there is this

“In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.” (page 108)

For some reason the House of Representatives believes that co-payments are good and coinsurance is bad. It’s not that one is more affordable than the other. All “cost-sharing” is limited to $5,000 per individual and $10,000 per family per year.

Most corporate HR people are trying to move away from co-payments in favor of coinsurance after many years of experiencing each. Coinsurance reveals to the consumer the underlying cost of the services consumed, while co-payments hide that knowledge.

And maybe that’s the point. The legislation is already hiding the cost of the insurance coverage by providing income-based subsidies. What a consumer will pay for coverage has no relationship to the cost of the coverage. It is institutionalizing ignorance.

And now it seems that the cost sharing within the insurance will bear no resemblance to the cost of the service. The “price” people pay will be just what we say it is, no more and no less.

If information is power, this is a deliberate effort to keep citizens powerless and enhance the power of the elite. Only the elite will know the real cost of anything and the citizenry will be dependent on their goodwill for the prices we pay

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