In areas of the country hardest hit by COVID-19, clinicians are already being forced to make tragic rationing decisions: about who to admit to the hospital, who to transfer to the ICU and who to place on scarce ventilators. These decisions feel out of character with our national identity. We normally think of ourselves as too wealthy, too committed to preserving American lives, to ration medical care.
However, rationing of American health care also takes place every day in subtler ways. We see that when a weekend tennis player with a sore shoulder decides to hold off on getting an MRI, or when a smoker with a touch of heartburn takes a few antacid tablets rather than schedule an appointment with her primary care physician. They delay care because their insurance companies require them to fork over copays and deductibles to cover the cost of these services, and they've decided that their money is better spent in other ways.
This may not sound like rationing on its face. But bear with me. Because when that "heartburn" turns out to be a heart attack, when that cough turns into a COVID-19 infection, delaying care to avoid out-of-pocket expenses can be deadly.
That's why we need legislation requiring private and government health care insurers to lift all copays and deductibles for at least the next three months, so no American delays necessary medical care out of fear of financial ruin.
In normal times, it makes sense to ask people to pay some portion of their medical care. A $250 copay incentivizes the weekend tennis warrior to decide whether he really needs that MRI. But people don't always know whether they need medical care. Scores of studies have shown that when people face high out-of-pocket costs, they not only seek out less wasteful medical care, but also delay the receipt of necessary care. Most people aren't doctors, after all, and can't be expected to know when they are dizzy from a minor cold or from an evolving stroke.
Recognizing the problems caused by such delays in care, the recently passed CARES Act stipulates that patients will not face any out-of-pocket charges for COVID-related testing and treatment, or for COVID vaccines if and when one becomes available. That's a great start. But it's not enough.
Suppose your neighbor Sam has a fever and his breathing feels labored. He calls his physician and is told to go to the ER, where he is admitted to the hospital. The hospital runs a free COVID test, and it's negative. Great news, except that Sam still has pneumonia from a different infection, and because of the details of his insurance coverage, he will be on the hook for 10 percent of the cost of his hospital stay.
It is insane to charge someone thousands of dollars simply because they had the "wrong" illness. It's even crazier to give people an incentive—"Did you hear how much Sam had to pay when he went to the hospital?"—to delay or avoid necessary medical care in the midst of a contagious pandemic.
I'm normally not a fan of completely free medical care. When care is free, people demand interventions they don't necessarily need at a price society can't afford. But these are not normal times. Until we have this epidemic under control, Congress needs to require insurers to waive copays and deductibles for any and all health care services.
Don't worry that waving copays will drive up demand for unnecessary care. To preserve resources for COVID patients, the U.S. health care system has already stopped performing elective tests and procedures. Offering free care now won't lead people to seek out trivial interventions; instead, it will keep them from delaying life-saving care. Waving copays will also slow the spread of the virus, because delaying care often means delaying self-quarantine.
Don't worry that insurers will be bankrupted by foregoing copays and deductibles for a few months. Congress will make the industry whole. But Congress can't do anything to undo the damage caused if people avoid receiving necessary interventions.
Charging people for medical care during a pandemic may be penny-wise, but it's awfully foolish.
Peter A. Ubel, M.D., is the Madge and Dennis T. McLawhorn University Professor of Business, Public Policy and Medicine at Duke University. A physician and behavioral scientist, Ubel is also author of Sick to Debt: How Smarter Markets Lead to Better Care.
The views expressed in this article are the writer's own.
