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Would healthcare costs in the United States be controlled better if people had more "skin in the game"? That is, if instead of insurance picking up the tab for everything, we had to pay more for medical services ourselves, making us a little more selective about what medical care we need and what medical care we don't? There's some evidence that says the answer is yes, and if it's implemented in a smart way (as in France, for example, where copay amounts vary depending on the value of the treatment) there might be a place for this. The problem, as Aaron Carroll pointed out a few days ago, is that Americans already pay more for medical services than residents of most other countries, but our healthcare costs are going up faster anyway.
But why do Americans pay so much? Part of the reason is that published averages include the uninsured, who have high out-of-pocket expenses. But that's not all. Even the insured, it turns out, have pretty high out-of-pocket expenses. Via Catherine Rampell, here's a chart from the Labor Department that shows coverage of various conditions by private sector health plans. It includes everything that's even partly covered, and as you can see, it leaves a lot to be desired. Sure, office visits and basic hospital costs are covered. But if you need an organ transplant or kidney dialysis or diabetes care? You're probably out of luck. Hell, even maternity care and physical therapy are a crapshoot. But just remember: America has the best healthcare in the world, baby. Don't let anyone ever tell you otherwise.