Skin in the game at Pizza Hut!

This morning I read Aaron Carroll’s nice piece on AcademyHealth’s blog noting that prices and not consumption are primarily to blame for the high health care costs in the U.S.

Fast forward a few hours later, and I am eating at Pizza Hut with the other chaperone’s for one of my kid’s school field trip and they ask what I do and I tell them. Immediately out of one dad’s mouth is “the problem with the health care cost problem is all the parasites of the system who don’t have enough skin in the game!” Back when I was blogging for the Incidental Economist, and something went wrong Austin used to say “I can hear Aaron screaming now.”

I heard Aaron Carroll scream around Noon today in a Durham Pizza Hut.

I went on to chat with the nice folks at my table about health policy for about 5 minutes or so and I talked about out of pocket costs, even for persons in Medicare and other salient points. He just looked at me like I had three heads (we weren’t drinking, it was a field trip). As we talked a bit more about employer provided insurance, I came to realize that he didn’t realize that his employer had paid the vast majority of the costs of his families private health insurance premium; he seemed to think his share was the total premium. In one sense, that could be understood as a “skin in the game” problem, and that he didn’t have enough because he had been shielded from the true cost of his health insurance. In economic terms I am quite confident that he has paid for that via lower wages, but this perspective is surely one of the negative by-products of employment being the primary way non elderly persons get health insurance.

I confess to despair at times about how we will ever make reasonable, evidence based health policy. Maybe we won’t. The technical problems are nothing compared to the cultural ones. The notion that what I have I earned and deserve, and what others have is both better and not deserved seems endemic in our country. It is enough to make someone scream. Go ahead Aaron, let one out for me.

update: I fixed a typo.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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