Podcast 135: ENCORE Rethinking the ‘Moral Hazard’ Approach to Structuring Health Insurance, with Christopher Robertson

4:26 – 4:36 Robertson: “In my view, that’s the primary design flaw, is that we’ve actually made health insurance incomplete. It doesn’t actually cover all of our needs reliably or predictably.”

7:25 – 7:29 Robertson: “The thought is that insurance is actually a huge driver of wasteful spending.”

10:57 – 11:18 Robertson: “There’s been a body of research that suggests that adding copays and exposure does reduce healthcare consumption. But the problem is … that the reductions in consumptions are indiscriminate. People reduce consumption for high-value care and low-value care alike.”

12:08 – 12:18 Robertson: “It does not seem … if you look at all the evidence together, that cost exposure is really a good tool for reducing wasteful health spending.”

14:38 – 14:50 Robertson: “More generally, I think cost exposure puts the pressure on the wrong actor in the system, because patients are not in the position to really assess value. The physicians are.”

19:47 – 19:55 Robertson: “The second big concern I have, aside from insurance cost exposure, is our lack of insurance for lost income.”

27:25 – 27:37 Robertson: “Although I’m a big critic of patient cost exposure, and a critic of obscenely high drug prices that don’t deliver value, when there’s value there, we need to be prepared as a society to pay for it.”